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DOI: 10.1055/s-0029-1246747
Aortic debranching procedure to facilitate endovascular stenting after repair of acute aortic dissection type A. Case report
Introduction: Patent false lumen of the aortic arch and the descending aorta is related to poor prognosis in patients who undergo surgery for acute type A dissection.
We describe a patient after acute type A aortic dissection and a patent dilated false lumen that was successfully treated by hybrid technique.
Case report: In 2006 a 57-year-old man underwent replacement of the ascending aorta for acute type A aortic dissection. Postoperative period was uneventful. In 2008 he was seen with recurrent visual disturbances and intermittent paralysis of the left and right arm.
Echocardiography showed a dissection membrane starting in the aortic arch.
Duplex of the Carotid arteries showed a dissection membrane as well.
CT scan showed normal perfusion of the conduit and a persistent dissection starting in the aortic arch up to both iliac arteries.
Because of the complex aortic pathology involving the aortic arch, carotid arteries, descending aorta up to the iliac arteries we decided to perform a hybrid operation combining an open supraaortic debranching using a bypass graft arising from the ascending aortic conduit to both carotid arteries and a crossover to the left subclavian artery and an endovascular stenting procedure of the aortic arch and the descending aorta.
Discussion: We found that the innovative combination of simultaneous conventional surgery and stenting procedures may avoid large thoracoabdominal incisions, cardiopulmonary bypass, deep hypothermia and circulatory arrest in selected patients.