Điều trị tổn thương phức tạp quai động mạch chủ bằng phương pháp hybrid

Abstract

Aortic disease is diverse and carries a high risk of sudden death if the patient has symptoms. The aortic arch disease may be aneurysm, dissection, artherosclerotic ulcer, pseudoaneurysm, coracrtation. The most common cause is hypertension, others are infection, connective tissue disease, trauma, congenital. Surgical treatment is the clasic method, but it has high risks for the patients who were recurrent operation, severe comorbidity diseases. The operative risks compose of severe bleeding, sternal infection, complications relate to long time of anesthesia. More than two decades ago, when the aortic stent graft intervention was introduced, the treatment of aortic diseases became easier and less invasive. This method changed strategy of aortic disease treatment. The principle of this method is that through the artery (usually the femoral artery), an artificial vessel (stent graft) is implanted inside the lumen of the aorta, covering over the injury position. One of the most important thing for stent graft intervention is that the healthy vascular portion from the vital vascular ostium (carotid artery, brachioencephalic artery, visceral artery) to the entrypoint of injury should be long enough to confirm the stent stably after implantation (the landing zone). This technique has become popular, easy to apply in many cathlabs in our country and in the world with a high success rate for Standford B type. However, with the injury in aortic arch, due to the short landing zone, which is the origin of many important blood vessels, the implantation of stent graft becomes much more complicated, requiring close coordination between the interventionist and the surgeon, this is called the hybrid method. Hybrid method includes the most complex techniques in aortic intervention. We used this method on series of 5 cases with feasible results, so we want to share our experience and knowledge about this technique.