Surgeons at the Madras Medical Mission (MMM) took an innovative approach to treat a complex aortic disease in a patient.
The patient was affected by malignant atherosclerosis extensively. The disease affected the walls of the blood vessels, causing both blockages and thinned out weak spots which balloon out and rupture.
A large ballooned-out portion of the aorta, the main blood vessel, squeezed the nerve to his voice box, changing the texture of his voice that led to the detection of an aneurysm. The aorta as it passed through the abdomen had two narrow spots. The arch or the main part from which the blood vessels to the brain arose was severely diseased and the aneurysm ballooned out from this part, according to a release.
Jacob Jamesraj, senior cardiac surgeon, MMM, planned to place a covered stent across the mouth of the aneurysm. This would normally be placed through the blood vessel in the thigh and it required a reasonably normal part of the aorta to land. In this patient, the thigh arteries were not suitable.
The proximal part of the aorta was made use of. The surgical team opened the chest and prepared the structures. A graft or an artificial blood vessel was fashioned into a Y-shaped bypass and sutured from the proximal part of the aorta to the brain’s blood vessels.
The team then moved the patient from the operating theatre to the catheterisation laboratory. Here, marking clips placed by the surgeon along with positioning catheters and fluoroscopy-guided the deployment of the stent. The stent plastered the walls of the aneurysm from the insides of the diseased aorta.
Dr. Jamesraj said the entire procedure took eight hours and the patient was shifted out of ICU on the same day. Benjamin Ninan, chief of anaesthesia, said a few years ago, a situation like this would have required a heart-lung machine and circulatory arrest which had its risks, the release said.
