Hybrid surgery in chronic thoracoabdominal aortic dissection

The authors describe and analyse their experience gained in performing prosthetic repair of the thoracoabdominal portion of the aorta, combined with open aortic stenting using the Djumbodis uncovered metal stent. Over the period from 2013 to 2015 we performed a total of 16 hybrid interventions. All patients were found to have type B aortic dissection, with their false and true lumens patent. All patients underwent reconstruction of the thoracoabdominal aorta combined with open implantation of the Djumbodis uncovered metal stent into the area of lower thoracic and visceral arteries. The patients underwent either isolated prosthetic repair of the thoracic aortic portion - type A correction, or prosthetic repair of the thoracic and infrarenal portions - type B correction. In the postoperative period we performed MSCT angiography of the thoracic and abdominal aortic portions in order to control patency of the true and false lumens, patency of visceral arteries, to assess the diameter of the aorta, presence or absence of thrombosis. All five patients subjected to type B correction (100% of the total number of this type operation) were found to develop thrombosis of the false lumen, and eight patients undergoing type A correction (72.7% of the total number of operations of this type) were diagnosed with false channel thrombosis. There was 1 (6.3%) lethal case registered at the hospital stage in the group of patients with type A correction. There were no cases of neurological deficit, malperfusion of visceral organs or lower-limb ischaemia. Our experience shows that using hybrid technologies in surgery of the thoracoabdominal portion of the aorta is (appears to be) optimal from the point of view of decreasing intraoperative trauma, reducing the complications rate and without detriment to the radicality.