Recently, Department of Interventional Vascular Surgery of Yulin Hospital of the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU) successfully adopted self-adjustable thoracic aortic covered stent to complete the first case of type IV hybrid surgery for complex thoracic aortic dissection in Northwest China, saving the life of this critically ill patient.
A 39-year-old male patient was admitted to Department of Cardiology of Yulin Hospital of the FAH of XJTU due to chest depression and palpitation for 1 year. Coronary angiography revealed that the patient suffered from complex thoracic aortic dissection, which was located at the opening of the left subclavian artery. The real aortic cavity was squeezed by a huge pseudomatoma, and the dissection was involved with the left common carotid artery and left subclavian artery. The patient's left vertebral artery was the dominant vertebral artery, and the mortality rate would be extremely high if left untreated.
After definite diagnosis, the patient was transferred to Department of Interventional Vascular Surgery. Medical Department organized joint consultations with relevant departments to determine treatment plans. It was agreed that surgical resection and replacement of the aortic arch would yield high surgical risk and a high risk of cerebral infarction. However, if only the interventional procedure was employed to perform covered stent implantation, internal leakage might be induced due to large rupture and involvement of the left common carotid artery and left subclavian artery, resulting in surgical failure. Considering young age and complex lesions, a hybrid surgical regimen combining surgery and interventional surgery was chosen after comprehensive communication with the patient's family.
After thorough preoperative preparations and with the cooperation from Department of Anesthesiology and Perioperative Medicine, Liu Jianlin, Director of Department of Interventional Vascular Surgery of Yulin Hospital, carried out the 6-h surgery as the chief surgeon, and successfully completed the left common carotid artery and left subclavicular artery artificial blood vessel bypass grafting. Simultaneously, the thoracic aorta was closed with self-adjustable covered stent. The proximal left subclavian artery and the pseudolumen of the dissected aneurysm was also successfully embolized.
This procedure completed by Hybrid Operating Room of Yulin Hospital of the FAH of XJTU is a novel and advanced surgical pattern. It is the first case of hybrid surgery for complex thoracic aortic dissection in Northwest China, signifying that Department of Interventional Vascular Surgery of Yulin Hospital of the FAH of XJTU has reached advanced levels in the diagnosis and treatment of complex thoracic aortic dissection in China.