Apollo Hospitals, Indore successfully performed its first hybrid procedure for ruptured Aortic Arch Aneurysm

An 80-year-old lady was having a huge dilation of the arch of the aorta, which was leaking and could have ruptured at any instance, causing instantaneous death. Her detailed work up in the form of aortic angiogram and CT aortic angiogram confirmed the diagnosis as well as the exact extent of the disease.

Open surgery would have involved a long incision and splitting of her breast bone, long general anaesthesia, stopping her heart, putting the patient on cardio-pulmonary bypass and then replacing the dilated aorta. She was too fragile to withstand the surgery. Endovascular treatment was the treatment of choice for her but the stent would have caused blockage of the arteries supplying her brains and upper limbs. This led doctors to go for a hybrid procedure – the first part was surgical and the second one – interventional endovascular stenting.

In the first part a team of surgeons involving Dr. Kshitij Dubey, Dr. Sushil Jain and Dr. Alok Biyani implanted a graft from her right artery of the brain to the left common carotid artery (supplying to the left side of the brain) and left subclavian artery (supplying to the left upper limb). This ensured that even if the mouths of the arteries are blocked by the stent, the blood supply will be maintained by the innominate artery through the graft. This was done under local anaesthesia thereby minimizing the risk of general anaesthesia.

Once the circulation to the brain and the upper limb was secured, interventional cardiologists Dr. Sarita Rao, Roshan Rao and Dr. Vikas Gupta under local anaesthesia, through a puncture in the right lower limb artery, implanted the bulky stent graft in the dilated part of the thoracic aortic aneurysm covering brain and upper limb artery which were already grafted so that there was no risk of any compromise to the brain and the upper limb.

Team effort by the surgical and the interventional team led to complete cure of the patient with minimal risk. The patient recovered well without any complications and was discharged from the hospital on the third post-operative day.