Successful Repair of a Giant Thoracic Aortic Aneurysm with De Bakey IIIB Dissection Using Hybrid Surgical Approach. A Clinical Case

, S.V. Korolev, T.E. Imaev, A.E. Komlev, P.M. Lepilin, I.S. Fedotenkov, A.S. KolegaevDepartment of Cardiovascular Surgery, Russian Cardiological Scientific and Production Complex of the Min-istry of Healthcare and Social Development of the Russian Federation, Moscow, RussiaThoracic aortic aneurysms account for about 20% of all aortic aneurysms. Their incidence is 6 per 100000 of patients per year (5). Aneurysm development is connected with media degeneration resulting from the insufficiency of all layers of the aortic wall. The risk of rupture is related to the increase of aortic diameter (7). In 33-50% of cases the rupture leads to death (5,8). Aortic dissection is a complex emergency situation, occurring twofold more frequently than abdominal aortic ruptures. The dissection of the aortic walls can cause dynamic or permanent obstruction, rupture or throm-bosis of the aortic branches.Open surgical intervention is a traditional standard treatment for this condition. The mortality associated with open interventions in the leading world centers is about 5-14% (for III type dissections) (10,11). The com-plications involve pulmonary, renal and cardiovascular systems and abdominal organs, thus significantly in-creasing the risk of death. Herewith the rate of complications is directly related to the size and the extension of the aneurysm. Concomitant diseases existing in many patients cause many problems related to open surgical interventions.With the account of open surgery-related risks, endovascular minimally invasive approach seems attractive and advantageous. The aim of endovascular aneurysm repair (EVAR) consists in the prevention of aneurysm rupture and aortic dissection by the way of aneurysmatic sac exclusion from the circulation, decreasing of the tension of aneurysmatic sac’s walls or of the pressure in the false lumen with its subsequent closure. In order to illustrate the up-to-date possibilities of the aortic dissection repair we present a clinical case of successful repair of a giant thoracic aortic aneurysm with De Bakey IIIB dissection and a parietal thrombosis using hybrid surgical method.