[Treatment of a patient with acute thoracoabdominal aortic dissection complicated by haemothorax]. / Lechenie patsienta s ostroi dissektsiei torakoabdominal'nogo otdela aorty, oslozhnennoi gemotoraksom.

Total left-sided haemothorax is a rare and severe complication of acute DeBakey type III aortic dissection. The primary aim of treatment is immediate arrest of haemorrhage and stabilization of the haemodynamic status of the patient. Endovascular isolation of the ruptured thoracic portion of the aorta using a stent graft (TEVAR) has recently become the 'gold standard' in treatment of acute, rupture-complicated aortic dissections of this localization. Described in the article is a clinical case report concerning successful endovascular treatment of a seriously ill patient with dissection of the thoracoabdominal portion of the aorta, rupture and massive haemorrhage into the left pleural cavity. The patient underwent endoprosthetic repair of the descending aorta in the setting of a hybrid operating room under local anaesthesia, followed by drainage of the left pleural cavity. The postoperative period was uneventful with no complications. The patient was discharged in a satisfactory condition on day 10 after the emergency surgical intervention. An important advantage of TEVAR for aortic ruptures is a minimally invasive nature of the procedure, consisting in no need to perform either sternothoracotomy or to connect a heart-lung machine, thus decreasing surgical wound, reducing the risk of perioperative life-threatening haemorrhage, and contributing to early activation of the patient.

[Hibrid surgical treatment of an aortic arch aneurysm]. / Gibridnoe khirurgicheskoe lechenie anevrizmy dugi aorty.

Presented in the article is a clinical case report regarding hybrid surgical management of a saccular aneurysm of the aortic arch: simultaneous right-left-carotid-left-subclavian bypass grafting and endovascular isolation of the aneurysm. Taking into consideration the findings of multislice computed tomography-aortography (MSCT aortography) prior to surgery, the anatomical location of the aneurysm with the involvement of the ostium of the left subclavian artery, close location of the proximal branches of the aortic arch at an acute angle relative to each other required performing simultaneous debranching in order to enlarge the proximal zone of fixation of a stent graft at the level of the brachiocephalic trunk (BCT). The postoperative period proved uneventful, with as rapid rehabilitation as possible. From our own experience, with this one being not the first similar operation performed in the Centre, it may be supposed that carrying out simultaneous hybrid interventions in treatment of aneurysms of the aortic arch with the use of different variants of switching its branches may decrease the frequency of postoperative complications for patients of high surgical risk, reduce the length of hospital stay and, consequently, economic expenditures for treatment.