HYBRID PROCEDURE A PATIENT WITH STANFORD TYPE B AORTIC DISSECTION WITH AORTIC ARCH RETROGRADA EXTENSION.

Abstract

Aortic dissection is considered one of the most catastrophic vascular diseases whose true incidence is difficult to estimate. According to the International Registry of Aortic Dissections (IRAD) risk factors for aortic dissection include, hypertension, Marfan syndrome, iatrogenic, cocaine consumption, bicuspid valve. Aortic dilatation is a well-established risk factor for AAD. This text presents present the case of a male patient, 52 years old, hypertensive, diagnosis of type B acute aortic dissection according to Stanford, with retrograde extension of the aortic arch, confirmed by echocardiography and Angiotac, with findings of bovine trunk, trivalic aortic valve and ascending aorta without alterations. , 3.8 cm aortic arch, a, with an old image of dissection flap at the birth of the bovine trunk (TB), which extends to the aortic arch to the right iliac, left renal involvement and celiac trunk. Hybrid procedure is performed, first surgical time: derivation of supra-aortic vessels by “Debranching” technique; 10 days later, second surgical time: endovascular repair of thoracic aorta (TEVAR), with discharge after 6 days. Conclusions: 1. The arch derailing is a procedure that presents satisfactory results as well as complications comparable to the conventional technique. 2. It has the benefit of carrying out the revascularization of the supra-aortic vessels outside of CPB, cardiac arrest and without circulatory arrest. 3. Minor surgical time, and rapid postoperative evolution. 4. Although it involves two surgical acts for the patient, with the inherent risks of the endovascular-surgical procedures, and represents greater cost in terms of inputs, this can be compensated for by the fact of not having had any complications, and represent a short Hospital stay given the magnitude of the pathology. Key woRds: Dissection of aortic arch, TEVAR, debranching, hybrid procedure. Doi: 10.34039/REV.CARD11/larez Clinical case