[Hybrid operative intervention for DeBakey type III aortic dissection with the relay stent graft]

Determining the exact incidence of aortic dissection is highly conjectural because many cases of the disease remain undiagnosed. According to the autopsy findings, the incidence rate of the pathology concerned varies within the range from 0.2 to 0.8%. In clinical practice, aortic dissection is the cause of sudden death in 1.1% of the patients involved. However, aortic dissection should by no means be considered a rare disease. According to Borst et ah, ruptures in thoracic-portion aortic dissections are encountered 2-3 times more often than tears occurring in abdominal aortic aneurysms. The prognosis for patients presenting with a chronic aortic dissection is unfavourable. The commonest complications of the natural course of the disease include the development of a secondary dissection, formation of an aneurysm, progression of aortic regurgitation and circulatory insufficiency, occlusion of the aortic branches, and a late aortic rupture being the immediate cause of death in 30% of patients suffering from chronic dissection. With the recent advent of stent grafts, there appeared a possibility in the majority of cases involving a chronic type B dissection by the Stanford classification to substantially avoid an otherwise inevitably traumatic and typically prolonged reconstructive operation. Unfortunately, in some patients, owing to anatomical peculiarities, it is not always possible to deploy an endograft, thus requiring a major surgical intervention to perform instead. The authors describe herein a case of endovascular prosthetic reconstruction of the aortic arch and the descending portion in a patient who was found to have a type III aortic dissection according to the DeBakey classification and treated with the Relay stent graft.