A Timeline From Index Procedure To Complex Reinterventions For Thoracoabdominal Aortic Dissection.

Abstract

The optimal management of acute type A aortic dissection (ATAAD) remains a controversial subject. While some surgeons opt for a hemiarch approach to minimize bypass and cross-clamping time, others prefer partial or total arch replacement to prevent the need for additional operations. The advent of hybrid approaches offers a variety of options to the aortic surgeon in treating ATAAD. Herein, we present a complex case of ATAAD requiring multistage reconstruction of the aortic arch and its branch vessels utilizing hybrid techniques. A 67-year-old man presented with chest pain and hypertension, leading to diagnosis of ATAAD. He initially underwent hemiarch replacement, which required multiple further interventions secondary to progressive thoracic aorta aneurysmal dilation, innominate artery dissection, and subclavian steal syndrome. A hybrid approach of open and endovascular techniques was utilized to treat the patient's pathology. ATAAD represents a challenging clinical entity in its acute, subacute, and long-term management. Currently, no consensus exists on ideal initial management of this disease. Nonetheless, new techniques such as fenestration of thoracic endografts can be utilized for the subsequent operations. Individualized care tailored to each case is the most effective management of this intricate disease.