Amrita Hospital doctors perform rare aortic arch keyhole repair

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Kochi, Nov 22 (UNI) In a rare keyhole repair of an aortic arch aneurysm, a team of cardiologists at a hospital here deployed a stent graft without an open chest surgery while preserving the blood flow to the brain.

Sharing the results of the surgery, done on a 61-year-old man from Goa on November 11, Dr K K Haridas of the Amrita Institute of Medical Sciences (AIMS) said at a press conference here today that the team also made use of the thoracic chimney procedure for the first time in the country, during the surgery.

The patient started improving soon after the surgery and all his symptoms subsided within a week. A CT scan repeated after a week confirmed the good result.

The procedure cost Rs five lakh, of which Rs 4.5 lakh was for consumables like the stent and graft, Dr Haridas said.

Aorta is the main blood vessel carrying pure blood to various parts of the body. As one ages, there is a tendency for the vessel wall to stiffen and weaken. This would result in dilatation of the vessel wall often to dangerous proportions. Till recently, the only option was to do open surgical repair, which carried a high risk of death, stroke and lower limb paralysis.

Keyhole repair (endovascular stent) was a relatively new technique in which a stent graft is deployed across the aneurysm to exclude it from the main vessel. Arch aortic aneurysms pose a great challenge as critical blood vessels to the brain and arms arise from this portion, he said.

The patient came with a large (8 cm) aneurysm of the aorta at the distal end of the arch of aorta which was eroding his vertebrae and ribs and compressing the wind and food pipes. There was also an imminent threat of rupture of the vessel.

In the surgery done under general anesthesia, one keyhole was put on the femoral (upper thigh) artery to carry the synthetic fabric graft into the aortic arch, a second keyhole was put in the neck vessel to introduce a stent to protect the blood vessel to the left side of the brain (chimney technique) while the third keyhole was put in the left artery to pass a device to occlude the vessel to the left arm to prevent blood leaking back into the aorta through the side of the graft.

The entire procedure lasted two hours.

The main advantage of the procedure was that it avoided major surgery and use of hear lung machine and the patient could walk about in 24 hours.

Apart from Dr Haridas, who led the team, the other doctors involved in the operation were Dr M V Jayakumar, Dr C Rajiv, Dr S Sudheendran and Dr G Unnikrishnan and anesthesiologist Dr Suresh G Nair.

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