Ahmet MEMİŞ, Hikmet İYEM, Yılmaz CİRBAN, Suat BÜKET

Yaygın aort anevrizmalı bir olgunun tedavisinde hibrit ve aşamalı tedavi

Bu yazıda açık cerrahi ve endovasküler stent greft kombinasyonu ile tedavi edilen yaygın aort anevrizmalı bir olgunun başarıyla gerçekleştirilen tedavisi sunuldu. Sağ femoral arter ve sağ atrial venöz kanülasyon yapılarak kardiyopulmoner bypass başlatıldı. Kardiyak arrest sonrası hastaya kompozit greft ile Bentall prosedürü uygulanırken hasta 18 dereceye kadar soğutuldu. İnen aortaya açık olan arkus aortadan antegrad açık teknikle 26 mm Talent endovasküler stent greft uzatıldı. Daha sonra total hemiarkus replasmanı için önce distal anastomoz yapıldı. Hasta ısıtılırken kompozit greftin distal ucu ile hemiarkus greftin proksimal uç anastomozu yapıldı. Bir hafta sonra periferik anjiyografi laboratuvarında genel anestezi altında inen aortaya ikinci stent greft yerleştirilerek tedavi tamamlandı.

Hybrid and staged repair in the treatment of a case with extensive aortic aneurysm

In this article we present a successful management of a case with extensive aortic aneurysm which was treated by a combination of open surgery and endovascular stent grafting. Cardiopulmonary bypass was established via right femoral and right atrial cannulation. Patient was cooled down till 18 degrees and following the cardiac arrest, Bentall procedure was performed by using a composite graft. A 26 mm Talent endovascular stent was placed into the descending aorta through arcus aorta under direct vision. Later on, distal anastomosis was performed for the total hemiarcus replacement. The distal part of the composit graft and the proximal part of the hemiarcus graft was anastomosed during rewarming. After one week, a second endovascular stent graft was placed into the descending aorta under general anesthesia in peripheric angiography laboratory and the treatment was completed.

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