Hybrid Strategy for Residual Arch and Thoracic Aortic Dissec
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Case Presentation
67-years-old retired professor, known hypertensive for 12 years and reformed smoker, underwent repair of type A aortic dissection 4 years back by supracoronary ascending aortic replacement with aortic valve resuspension. He later presented with worsening dyspnoea and left sided chest pain over the past 1 year. On evaluation he had lower blood pressure on left upper limb as compared to the right with gradient of 20?mmHg. All peripheral pulses were palpable. Laboratory parameters, electrocardiogram, and echocardiogram were normal. CT angiogram revealed patent mid ascending aortic prosthetic graft with native aortic root and normal coronaries, with dissection flap noted in the arch and descending aorta extending across the abdominal aorta up to the bifurcation of right common iliac artery. Innominate, left common carotid, celiac, superior mesenteric, and right renal arteries were arising from true lumen. Flap was noted extending into left subclavian artery (SCA) and left renal artery with hypoperfusion of left kidney. Aneurysmal false lumen measured a maximum diameter of 73?mm in upper descending thoracic aorta (DTA). Debranching of the arch vessels was undertaken as 1st stage of the hybrid repair using a 10?mm knitted bovine gelatin coated polyester graft (Uni-graft K DV, Braun Aesculap, Tuttlingen, Germany) for bypass from ascending aortic prosthesis to the right common carotid artery, piggybacking 8?mm grafts to left common carotid artery and left subclavian artery.....