Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm
OBJECTIVE. Assessment of the mid-term results after various types of debranching in hybrid surgery of the aortic arch and descending thoracic aorta.METHODS AND MATERIALS. 47 patients with various pathologies of the aortic arch and descending thoracic aorta were operated on. Six of them suffered from...
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Pavlov First Saint Petersburg State Medical University
2022-09-01
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| Series: | Вестник хирургии имени И.И. Грекова |
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| Online Access: | https://www.vestnik-grekova.ru/jour/article/view/1562 |
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| author | V. V. Shlomin P. B. Bondarenko E. A. Shloydo P. D. Puzdriak Yu. P. Didenko I. R. Uzhakhov K. A. Petrova A. V. Gusinskiy A. A. Erofeev K. R. Akimova |
| author_facet | V. V. Shlomin P. B. Bondarenko E. A. Shloydo P. D. Puzdriak Yu. P. Didenko I. R. Uzhakhov K. A. Petrova A. V. Gusinskiy A. A. Erofeev K. R. Akimova |
| author_sort | V. V. Shlomin |
| collection | DOAJ |
| description | OBJECTIVE. Assessment of the mid-term results after various types of debranching in hybrid surgery of the aortic arch and descending thoracic aorta.METHODS AND MATERIALS. 47 patients with various pathologies of the aortic arch and descending thoracic aorta were operated on. Six of them suffered from type IIIa dissection and 26 from type IIIb dissection according to DeBakey classification, 15 patients had true aortic aneurysms. The following interventions were performed: total aortic arch debranching (n=5), cross subclavian-subclavian-left-common carotid (n=14) or cross carotid-carotid-subclavian bypass (n=7); subclavian-carotid transposition or bypass (n=12); Chimney technique for the aortic arch aneurysm (n=8); in situ fenestration of the endoprosthesis (n=1). Elective surgery was performed in 32 patients, emergency in 15.RESULTS. Technical success achieved in 100 %. The overall hospital mortality rate was 10.6 % (n=5), elective surgery mortality rate was 9.3 % (n=3), in emergency cases - 13.3 % (n=2). Causes of mortality: stroke (n=1), multiple organ failure after prosthetic ascending aorta due to retrograde dissection after stent graft implantation (n=1), pneumonia (n=1), acute myocardial infarction (n=1), profuse bleeding (n=1). Cumulative survival rate was 87.5 % over 5 years, freedom from reinterventions - 89.1 %. During the first year of observation, 3 patients underwent stent graft replacement of the descending thoracic aorta due to formation of a dissection below the primary stent graft (n=1), open prosthesis of the ascending aorta due to it retrograde dissection (n=1), endofixation of the stent graft with embolization of the false lumen (n=1).CONCLUSION. Hybrid surgery on the aortic arch and the descending thoracic aorta is safe and effective treatment. Regular follow-up and timely treatment of complications in the long term after hybrid or endovascular interventions are necessary to improve long-term results. |
| format | Article |
| id | doaj-art-cd829e2fe54242bf9eac2aaf023ebd76 |
| institution | DOAJ |
| issn | 0042-4625 |
| language | Russian |
| publishDate | 2022-09-01 |
| publisher | Pavlov First Saint Petersburg State Medical University |
| record_format | Article |
| series | Вестник хирургии имени И.И. Грекова |
| spelling | doaj-art-cd829e2fe54242bf9eac2aaf023ebd762025-08-20T03:23:30ZrusPavlov First Saint Petersburg State Medical UniversityВестник хирургии имени И.И. Грекова0042-46252022-09-011811112010.24884/0042-4625-2022-181-1-11-201358Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysmV. V. Shlomin0P. B. Bondarenko1E. A. Shloydo2P. D. Puzdriak3Yu. P. Didenko4I. R. Uzhakhov5K. A. Petrova6A. V. Gusinskiy7A. A. Erofeev8K. R. Akimova9City Multiservice hospital № 2Almazov National Medical Research CentreCity Multiservice hospital № 2City Multiservice hospital № 2; North-Western State Medical University named after I.I. MechnikovCity Multiservice hospital № 2City Multiservice hospital № 2North-Western State Medical University named after I.I. MechnikovAlmazov National Medical Research CentreCity Multiservice hospital № 2City Multiservice hospital № 2OBJECTIVE. Assessment of the mid-term results after various types of debranching in hybrid surgery of the aortic arch and descending thoracic aorta.METHODS AND MATERIALS. 47 patients with various pathologies of the aortic arch and descending thoracic aorta were operated on. Six of them suffered from type IIIa dissection and 26 from type IIIb dissection according to DeBakey classification, 15 patients had true aortic aneurysms. The following interventions were performed: total aortic arch debranching (n=5), cross subclavian-subclavian-left-common carotid (n=14) or cross carotid-carotid-subclavian bypass (n=7); subclavian-carotid transposition or bypass (n=12); Chimney technique for the aortic arch aneurysm (n=8); in situ fenestration of the endoprosthesis (n=1). Elective surgery was performed in 32 patients, emergency in 15.RESULTS. Technical success achieved in 100 %. The overall hospital mortality rate was 10.6 % (n=5), elective surgery mortality rate was 9.3 % (n=3), in emergency cases - 13.3 % (n=2). Causes of mortality: stroke (n=1), multiple organ failure after prosthetic ascending aorta due to retrograde dissection after stent graft implantation (n=1), pneumonia (n=1), acute myocardial infarction (n=1), profuse bleeding (n=1). Cumulative survival rate was 87.5 % over 5 years, freedom from reinterventions - 89.1 %. During the first year of observation, 3 patients underwent stent graft replacement of the descending thoracic aorta due to formation of a dissection below the primary stent graft (n=1), open prosthesis of the ascending aorta due to it retrograde dissection (n=1), endofixation of the stent graft with embolization of the false lumen (n=1).CONCLUSION. Hybrid surgery on the aortic arch and the descending thoracic aorta is safe and effective treatment. Regular follow-up and timely treatment of complications in the long term after hybrid or endovascular interventions are necessary to improve long-term results.https://www.vestnik-grekova.ru/jour/article/view/1562thoracic aortic aneurysmaortic dissectionthoracic aortic endoprostheticshybrid aortic surgerycomplications after endoprostheticsdebranchingchimney |
| spellingShingle | V. V. Shlomin P. B. Bondarenko E. A. Shloydo P. D. Puzdriak Yu. P. Didenko I. R. Uzhakhov K. A. Petrova A. V. Gusinskiy A. A. Erofeev K. R. Akimova Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm Вестник хирургии имени И.И. Грекова thoracic aortic aneurysm aortic dissection thoracic aortic endoprosthetics hybrid aortic surgery complications after endoprosthetics debranching chimney |
| title | Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm |
| title_full | Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm |
| title_fullStr | Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm |
| title_full_unstemmed | Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm |
| title_short | Efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm |
| title_sort | efficiency of hybrid surgical treatment of the aortic arch and descending thoracic aorta aneurysm |
| topic | thoracic aortic aneurysm aortic dissection thoracic aortic endoprosthetics hybrid aortic surgery complications after endoprosthetics debranching chimney |
| url | https://www.vestnik-grekova.ru/jour/article/view/1562 |
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