Infrarenal Abdominal Aortic Dissection ? Hybrid Treatment: Case Presentation

Background: The first reports of hybrid surgery were in 1970. Since then, their numbers have grown exponentially with the development of endovascular techniques. The procedures were initially performed in the angiography laboratory by a mixed team of surgeons - cardiologists or interventional radiologists, but the current trend is to be performed in hybrid rooms by the vascular surgeon. Infra-renal abdominal aortic dissections are a rare pathology, with a challenging treatment.

Methods: We present a case of a 63 years old man, with high risk cardiovascular comorbidities (obesity, diabetes mellitus, and hypertension); The CT multi-slice of the abdominal aorta revealed a dissection of the terminal aorta, involving the right common iliac artery, compressing the true lumen, which remains at 20%. Because of the multiple comorbidities, we have decided in vascular team to use an aortouni-iliac endograft with bilateral surgical femural access and an extraanatomical bypass (femoro-femoral) with a Dacron silver graft nr. 8 (Interguard Synergy, Maquet-Terumo) in the same procedure. The patient received a locoregional anesthesia. The intervention was done in the Cath lab with a mixed team ? Surgeon, Interventional Cardiologist, Anesthesiologist

Results: The post-operatory suits were simple and the patient was discharged in the 4th day. He received oral anticoagulation for at least 3 months. We attached the one month post-operative CT.

Conclusions: In conclusion, hybrid procedures, performed in patients at high surgical risk, have similar results to standard or endovascular surgical treatment, in short and medium terms, but with lower morbidity and mortality and shorter stay time in intensive care and hospitalization.

Fig. 1 Preoperative CT scan.

Fig. 2 Aortouni-iliac stent graft.

Fig. 3 Femoro-femoral graft.

Fig. 4 CT scan at one month.

References

1. Wu J, Zafar M, Qiu J, et al. A systematic review and meta-analysis of isolated abdominal aortic dissection. J Vasc Surg 2019;70(6):2046–2053.e6 PubMed

2. Sen I, D’Oria M, Weiss S, et al. Incidence and natural history of isolated abdominal aortic dissection: A population-based assessment from 1995 to 2015. J Vasc Surg 2021;73(4):1198–1204.e1 PubMed

3. Zlatanovic P, Dragas M, Cvetkovic S, et al. Open Surgical Treatment of Acute Spontaneous Isolated Abdominal Aortic Dissection. Ann Vasc Surg 2021;74:525.e13–525.e21 PubMed

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
10 June 2022