Simultaneous Ascending Aortic Replacement and Thoracic Endovascular Aortic Repair (TEVAR) in Acute Aortic Syndrome

1.39.15. Simultaneous Ascending Aortic Replacement and Thoracic Endovascular AorticRepair (TEVAR) in Acute Aortic SyndromeIbrahim Pir 1, Saad Naddaf 1, Eyüp Serhat Çalık 1 and Münacettin Ceviz 21 Department of Cardiovascular Surgery, Atatürk University Medical Faculty, Erzurum,Turkiye2 Department of Cardiovascular Surgery, Buhara Hospital, Erzurum, TurkiyeBackround: The term acute aortic syndrome (AAS) refers to a group of situationsin which there is a danger of impending aortic rupture and treatment delays result inincreased mortality. We aim to present the use of an endovascular and surgical hybridapproach to treat acute aortic syndrome. The method is a single-step procedure used totreat severe aortic disease withouth using hybrid operating room.Case Presentation: Five hours after beginning of acute and severe chest and back pain,a 62-year-old woman was referred to our department from cardiology. The patient washemodynamically stable, hypertensive and had a history of Takayasu arteritis. Ascendenaort aneurysm, intramural hematoma (IMH) and a Stanford type B aortic dissection werefound in computed tomography (CT). The patient was immediately operated on, undergeneral anesthesia, and extracorporeal circulation was initiated with femoral cannulation.Then the patient underwent TCA. The ascending aortic aneurysmatic segment was removed.The TEVAR procedure was completed with direct view and the ruptured thoracic aorticsegment was treated by opening the Medtronic captiva 30 × 30 × 200 mm stent graftover the hard wire as zero to the origin of the left subclavian artery. Then Ascendingaortic replacement was completed. The patient’s post-procedure recovery was clinicallyuneventful. The patient was discharged on the seventh day after the operation. WeMed. Sci. Forum 2025, 31, 1 177 of 249demonstrate the efficacy and anatomical feasibility of combining open surgery with anendovascular method to treat ascenden aort aneurysm and aortic dissection of the thoracicaorta simultaneously. Endovascular intervention performed during open surgery makesthe operation easier due to direct vision. Considering the complications and difficulties ofthoraco-abdominal surgery, this hybrid approach appears to significantly reduce surgicalmorbidity and mortality.Keywords: Acute aortic sendrome; ascending aortic replacement; hybrid approach; TEVAR<br>