On July 30, a 32-year-old man with signs of a ruptured thoracic aorta was urgently taken by ambulance to Almazov Centre from the Pskov region. It is known from the patient history that at the age of 6 he was diagnosed with coarctation of the aorta, a congenital defect, for which he underwent endovascular surgery (balloon angioplasty). Afterwards, the patient was not followed up much by doctors.
A week ago, the patient suddenly developed acute back pain and hemoptysis. The patient in severe condition was admitted to the Pskov regional hospital with persistent hemoptysis and intractable pain syndrome. Following the recommendation of the doctors from Almazov Centre, he underwent MSCT aortography which revealed a thoracic aortic aneurysm in the coarctation area measuring up to 8 * 7.5 cm with signs of rupture. Aneurysm formation was probably caused by balloon angioplasty of this area performed earlier in childhood. The patient was taken to Almazov Centre for emergency surgery.
Despite the instability of hemodynamic parameters and massive blood loss, the team of vascular surgeons headed by the chief of Research Department of Vascular and Interventional Surgery, Dr. Mikhail Chernyavsky performed endovascular repair of the thoracic aortic aneurysm through a small 3 cm incision in the right groin. The surgery lasted for 40 minutes. The doctors removed the ruptured section of the aorta and stopped further bleeding which could have been fatal. A day later the patient was transferred from the intensive care unit to the regular ward. The patient still remains in the hospital facing a long and difficult recovery period but the main threat from massive bleeding has now been eliminated.
If such a complication develops and no emergency surgery is performed, mortality is 100%. There is no doubt that the use of cutting-edge interventional technologies such as thoracic endovascular aneurysm repair (TEVAR) is the only chance to save a patient's life.
The minimally invasive technique of treating this condition reduces hospital mortality due to local anesthesia, shorter duration of surgery and lower injury rate. The life-saving surgery was successfully performed on the young man thanks to the advanced facilities at Almazov Centre, professional expertise of vascular surgeons and wise interaction of colleagues from the regions and the air ambulance team.