Extra-anatomic bypass with open-plugging stent graft for extensive dissected aortic aneurysm

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Disease

Background:

• Extensively dissected aortic aneurysms pose significant surgical challenges.
• Open surgery via left thoracotomy is an option but carries risks for patients with pulmonary comorbidities.
• Standard hybrid strategies may not be feasible for complex thoracoabdominal aortic dissections.

Purpose of the Study:

• To describe a successful surgical treatment for a complex case of chronic type B aortic dissection with aneurysmal change and ascending aortic dilation.
• To present an alternative surgical strategy when standard hybrid approaches are not possible.

Main Methods:

• Ascending aortic replacement with cervical vessel reconstruction.
• Extra-anatomic bypass from the ascending to descending aorta with aneurysmal isolation.
• Stent graft insertion into the true lumen of the residual aneurysm to reduce endopressure.

Main Results:

• Successful total thrombosis of the aneurysm was achieved.
• Significant reduction in aneurysm size was observed.
• The patient experienced a good recovery without complications.

Conclusions:

• This complex surgical technique offers a viable solution for extensively dissected aortic aneurysms, even when standard methods fail.
• The combination of aortic replacement, bypass, and endovascular repair can effectively manage challenging aortic pathologies.
• This approach demonstrates successful aneurysm exclusion and patient stabilization.