A Hybrid Treatment for a Giant Subclavian Artery Aneurysm

Surgical treatment of aneurysms of the is a serious clinical challenge due to the complexity of surgical treatment. The method of hybrid surgical treatment using temporary balloon occlusion of the brachiocephalic trunk is the most optimal in open surgery, which optimizes the conditions for surgical intervention, minimizes the risks of intraoperative complications and affects the treatment outcomes. Patient M., 62 years old, was admitted to the vascular surgery department of the State Budgetary Healthcare Institution prof. S.V. Ochapovsky Research Institute — Regional Clinical Hospital No. 1 in June 2024 year with complaints of chest and spine pain of a girdle nature. Multispiral computed tomography with intravenous contrast revealed: aortic dissection type III B according to DeBakey - Belov, aneurysm of the right anterior aortic aneurysm. A hybrid surgical intervention was performed. The patient was offered a two-stage surgical treatment: thoracic aortic endoprosthetics with stent-graft implantation, resection of the aneurysm of the thoracic aorta and its prosthetic replacement. After implantation stent graft during CT dynamics in the early postoperative period revealed signs of endoleak stent graft Type I B. After 11 days, a repeat thoracic aortic endoprosthesis was performed with stent graft implantation. The endoleak was isolated. After 5 months, the patient underwent the second stage of treatment in the volume resection of the aneurysm of the cerebral artery, which, due to the anatomical features of the aneurysm of the cerebral artery, was performed using a hybrid method. The duration of the surgical intervention was 190 minutes. The anastomosis formation time was 20 minutes, and the occlusion time was 55 minutes. The volume of intraoperative blood loss was about 50 ml. The patient was extubated 10 minutes after the end of the operation on the operating table and transferred to the intensive care unit. The postoperative period was uneventful. On the 3rd and On the day after the operation the patient was activated and transferred to the general ward from the intensive care unit. On the 7th day the patient was discharged from the hospital in satisfactory condition.