Proactive Intervention for Bleeding Control in Surgery for Complex Aortic Disease: a Hybrid Approach

Uoc H. Nguyen, Son T. Nguyen, Tien N. Le

Cardiovascular and Thoracic Center, Viet-Duc Univesity Hospital, Hanoi Medical University, Hanoi, Viet Nam

Date, time and location: 2018.05.26 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective: proactively bleeding control prior to access to lesions is a major challenge for conventional surgery in the treatment of complex aortic diseases (AoD), such as supra-renal AoD, the aorto-visceral arteries, of arteries from the aortic cross, infection disease. Report to introduce proactive bleeding control (PBC) technology by endovascular intervention at Viet Duc Hospital. Methods: complex AoD, treatment by classical surgery with PBC by endovascular intervention, from December 2014 to December 2017, about technique and advantages of PBC and surgical results. Includes 8 cases: 7/8 was male, age from 29 to 60 y.old. Diagnosis were: Supra-renal aortic aneurism (3); False supra-renal aortic and trunk celiac aneurism + superior mesenteric stenosis (1); False supra-renal aortic aneurism (1); Supra-renal aortic penetrating wound (1); Le Riche with supra-renal occlusion (1); False aneurism due to brachiocephalic trunk arterial injury + isthmic aortic rupture / multi organic trauma (1). Results: (1) PBC technique: aortic catheter entry through the external iliac artery (5) and brachial artery (3); more convenient by brachial entry for abdominal aortic replacement. Use the aortic balloon (type for stent-graft) to control the flow in the aorta (5 - 25 minutes) on juxta-lesion position, under the guidance of the C-arm Mini-Cathlab OEC 9900. Hemostasis of entries by classical surgery. (2) The benefits of PBC: less surgical intervention for classical aortic clamp - a very difficult and invasive time; extensive surgical field, faster and simpler surgical techniques - reduce the time of the aortic clamp ...; postoperatively very light. (3) The results of surgery are favorable, with: postoperative ventilation time from 30 minutes to 18 hours, no postoperative complications, control examination has good results. Conclusions: surgery for complex AoD with PBC can be considered a form of Hybrid therapy for vascular disease. This method is safe and has many benefits for surgery and patients.