A team of doctors took a hybrid approach to treat two patients with traumatic aortic injury and thoracic aortic disease.

The patients — a 46-year-old police official who had suffered a tear in the aorta, a major blood vessel of the body, and a 55-year-old shopkeeper, who had earlier undergone aortic dissection, and had a residual dissection in the lower half of his body growing in size and causing severe pain — underwent the hybrid aortic arch procedure at the Madras Medical Mission (MMM).

According to a press release, the police official had sustained multiple injuries in a road traffic accident. He had multiple fractures of the ribs and a vertebra with spinal cord compression. The injury caused a tear in the aorta.

Anbarasu Mohanraj, senior cardiac surgeon, MMM, said traumatic rupture of the thoracic aorta was a life-threatening lesion and occurred in 10 to 30% of fatalities from blunt thoracic trauma.

Delayed repair of traumatic aortic injuries have significant survival benefits and a much lower mortality rate when compared to early open repair, he said. Extensive surgery with the cooling of the body to 16 degree Celsius, stopping the blood supply to the whole body and replacing that part of the aorta with a synthetic graft was the routine treatment till a few years ago.

Ezhilan J., head, Peripheral Vascular Department, MMM, said hybrid procedures have come for the safe management of such complex cases. As a first step in the operation theatre, blood vessels supplying the brain, spinal cord and upper limb are bypassed, creating a landing zone for the stent to be deployed. After this, an endovascular stenting of the thoracic aorta is done in the cath lab (catheterisation laboratory).

The second patient had extensive surgery for aortic dissection in 2017. The ascending aorta and the arch of the aorta was replaced preserving his aortic valve. The residual dissection in the lower half of his body that could not be repaired in a single stage was growing in size to 80 mm and causing pain. He was treated in a similar way.

Both patients recovered and were discharged five days later, the release added.

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