Almazov Centre is a flagship medical centre for the introduction of innovative technologies and treatment methods for patients with cardiovascular diseases. Each year, the number of patients receiving high-tech medical care, even for the most challenging diseases of the aorta and peripheral arteries, continues to grow as a result of the integration of the latest technologies into daily clinical practice.
On 25 April 2024, a team of vascular surgeons, anesthesiologists and nurses from Almazov Centre, led by Dr. Mikhail Chernyavsky, Chief of the Research Department of Vascular and Interventional Surgery, performed a unique endovascular surgery on a 71-year-old woman with a thoracoabdominal aortic aneurysm. The procedure, which lasted five hours, involved the implantation of a customized branched stent-graft, comprising five different modules, into the thoracoabdominal aorta. In addition, endovascular repair was performed on all visceral vessels branching from the aorta, thus preserving the blood supply to the abdominal cavity organs.
Preoperative CT and control intraoperative angiography after the implantation of a branched stent graft
The technical challenge was due to the non-standard anatomy of the aorta, which was the result of the patient having previously undergone aortic arch and descending aortic surgery. The first aneurysm surgery was performed by the Borst Elephant Trunk technique at Almazov Centre in 2020. This included the surgical repair of the ascending section and aortic arch using the vascular graft, as well as the reimplantation of the brachiocephalic arteries. A second stage several months later was the implantation of a stent graft in the descending aorta, thus completely isolating the aneurysm. One year after the surgery, a follow-up examination revealed that the aneurysmal dilation had started to spread lower. This necessitated the implantation of an additional stent-graft module in the thoracic aorta, up to the level of the main branches of the abdominal aorta. The surgery was successfully performed at Almazov Centre, and the patient was discharged for outpatient follow-up by the Centre's vascular surgeons.
Following two years of dynamic follow-up, a CT scan revealed further growth of the aneurysm, with its spread to the thoracoabdominal region. This is where all vital arteries feeding the internal organs branch off. Given severe comorbidities and the risks of bleeding and damage to the thoracic organs during repeated open surgery in this area, it was decided that an endovascular minimally invasive intervention for endovascular aortic repair would be the most appropriate course of action. This approach does not require extensive traumatic access. Despite the patient having undergone previous interventions, the Centre's vascular surgeons successfully performed the most complex surgery, saving the patient's life and health. The patient was transferred to the ward on the first day and was able to resume her normal life.