Možnosti použití kombinace chirurgických a endovaskulárních technik v léčbě rozsáhlých aneuryzmat a disekcí hrudní aorty

Options for Combining Surgical and Endovascular Techniques in the Management of Large Aneurysms and Dissections of the Thoracic Aorta

The surgical management of aneurysms and dissections of the thoracic aorta, as well as their endovascular management, all have their technical and medical limits. The aim of this work is to point out possibility for combination of the both treatment methods and to share our first practical experience with this procedure. The procedures conducted have been divided into the following groups:

– combined procedures, where the surgical part enables implantation of the stentgraft into the descending aorta or is managing imperfect results of such implantations,

– procedures, where combining the surgical and endovascular treatment lowers operational stress of the patient, as the extracorporeal circulation and the circulation arrest are not required,

– procedures, where advantages of both the surgical treatment in the region of the aortic arch and the endovascular treatment in the region of the descending aorta, are combined.

Using the combination of both the surgical and endovascular techniques in the management of the large aneurysms and dissections of the thoracic aorta, appears to be a perspective method. The patient may benefit from its lower perioperative risk rates and lower postoperative morbidity rates. A good long-term effect of the above treatment method may be expected, however, it has to be verified in long-term patient studies.

Key words:
aneurysms of the thoracic aorta – dissection – endovascular treatment – hybrid procedure