[Experience with implantation of a fenestrated endoprosthesis to a patient with a juxtarenal aortic aneurysm].

In patients with a juxtarenal abdominal aortic aneurysm the unaltered segment is frequently insufficient to secure adequate proximal fixation of the stent graft or is entirely absent, thus making it problematic to exclude the aneurysm from the blood flow by means of classic endoprosthetic repair. For this reason, in order to preserve the blood flow through visceral and renal arteries fenestrated endoprostheses are used as alternative minimally invasive treatment policy. Described herein is the first in the Russian Federation clinical case of using a fenestrated endovascular graft for treatment of a juxtarenal aortic aneurysm. Our patient had high surgical risk due to severe concomitant pathology and was therefore subjected to implantation of a fenestrated endoprosthesis with the preservation of the blood flow through the superior mesenteric artery and both renal arteries. The operation was successful with the complete exclusion of the aneurysm from the blood flow. The first and subsequent controls in the postoperative period showed an adequate position of the endoprosthesis and normal blood flow through the visceral branches.

[A clinical case of endovascular prosthetic repair of a gigantic abdominal aorta aneurysm].

To illustrate the present-day possibilities in treatment of aortic dissection we describe herein a clinical case report concerning successful prosthetic repair of a gigantic aneurysm of the infrarenal portion of the aorta with the Gore Excluder using an endovascular surgical approach in a patient running high risk associated with difficult anatomy of the abdominal portion of the aorta, iliac arteries, and accompanying diseases (left lung cancer, CAD, critical stenosis of the RCA. This was followed by balloon angioplasty with stenting of the RCA with Lekton stents with a good angiographic result. EVAR has become an alternative to the conventional open surgery with lower risk of complications, shorter hospital stay, and decreased mortality rate, which was confirmed by the findings of international studies.

[Hybrid surgical management of a saccular aneurysm of the aortic arch].

The present article aims to describe a clinical case of hybrid surgical intervention consisting in complete prosthetic repair of the aortic arch in a high-risk male patient diagnosed with a gigantic saccular aneurysm of the aortic arch. The patient was subjected to a hybrid operation--an operation of endovascular prosthetic repair of the thoracic portion of the aorta with the Gore Tag stent graft in a combination with bypass grafting of the left common carotid and left subclavian arteries with the Gore bifurcated stent graft, autovenous aortocoronary bypass grafting of the CA without artificial circulation. The postoperative period was uneventful with the patient's favourable convalescence and rehabilitation occurring within the shortest terms possible. According to the findings of MSCT-aortography, fulfilment of the arteries of the aortic arch with contrast medium was satisfactory. The residual cavity of the aneurysm was completely isolated from the blood flow, with no endoleak. The arteries of the aortic arch were opacified through the bifurcation prosthesis from the ascending portion of the aorta. Hybrid surgical interventions appear to possess all positive properties of endovascular (according to the findings of the EVAR1 and EVAR2 Trials) and traditional open surgery, thus allowing of both avoiding threatening complications and minimizing the terms of rehabilitation. This technique might thus be considered a useful tool to be included into the basic armamentarium of the vascular surgeon as an option of revascularization.