Article Sidebar
Views PDF: 218
Wrapping technique of ascending aorta in Hybrid procedure for complex aortic arch disease
Main Article Content
Abstract
Background: The hybrid procedure proved to be very suitable for Vietnamese conditions in the treatment of complex aortic diseases in the arch and on supra-renal lesion. There is a difficult situation when the ascending aorta is more dilated than can be accommodated by stent-grafts. Wrapping techique is a solution to this situation. Methods: Report on a clinical case of successful application of aortic wraping technique to treat complex aortic cross injuries at Cardiovascular and Thoracic Center, Viet Duc University Hospital. Results: A 73-year-old female patient was admitted to the hospital because of sudden chest pain. History of high blood pressure, heart failure, dyslipidemia and hypothyroidism. MSCT revealed type B aortic dissection, left hemothorax complication, the entire ascending aorta and a part of cross dilated to 50mm (maximum stent-graft size is 46mm). Poor general condition, severe and complicated acute aortic injury, if the classic surgery requires total thoracic aorta replacement – the risk of death is very high, so the hybrid solution is a reasonable choice if having the solution is to solve the problem to create a landing zone for stent-graft. Hybrid surgery was started with open sternotomy, bilateral aortic - carotid bypass with Dacron prothesis 9mm, using a large artificial vessel to wrap around the ascending aorta to reduce the medium size to 38mm. Drain and close the sternum. Next is endovascular intervention – installing a stent-grafts of 42x42x200 and 42x38x150 then 38x34x150 to the diaphragm, plug for left subclavian artery. Left pleural drainage. The patient was discharged 10 days after surgery. Follow-up after 2 years for good results. Conclusion: The hybrid procedure can still be applied in the situation of ascending aorta dilatation with wrapping technique – decreasing the size of the aorta to fit the size of the stent-graft in some high-risk situations. with classic surgery.
Article Details
Keywords
wrapping technique for aortic disease, hybrid procedure, aortic cross
References
2. Pecoraro F, Lachat M, Hofmann M, Cayne NS, Chaykovska L, Rancic Z, et al. Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients. Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):882–9.
3. Antoniou GA, El Sakka K, Hamady M, Wolfe JHN. Hybrid Treatment of Complex Aortic Arch Disease with Supra-aortic Debranching and Endovascular Stent Graft Repair. Eur J Vasc Endovasc Surg. 2010 Jun 1;39(6):683–90.
4. Gelpi G, Vanelli P, Mangini A, Danna P, Contino M, Antona C. Hybrid Aortic Arch Repair Procedure: Reinforcement of the Aorta for a Safe and Durable Landing Zone. Eur J Vasc Endovasc Surg. 2010 Dec 1;40(6):709–14.
5. Roselli EE, Idrees JJ, Johnston DR, Eagleton MJ, Desai MY, Svensson LG. Zone zero thoracic endovascular aortic repair: A proposed modification to the classification of landing zones. J Thorac Cardiovasc Surg. 2018 Apr;155(4):1381–9.
6. Kolvenbach R, Karmeli R, Rabin A, Lica R. Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study. J Endovasc Ther. 2019 Oct 1;26(5):658–64.
7. Soares AMMN, Sá MPBO, Neto ACE, Cavalcanti LRP, Zhigalov K, Weymann A, et al. Wrapping of ascending aortic aneurysm with supra-aortic debranching and endovascular repair for aortic arch aneurysm and ruptured descending thoracic aortic aneurysm. J Card Surg. 2020;35(2):503–6.