A ruptured thoracoabdominal aortic aneurysm is an urgent situation requiring emergency surgery during which it is necessary to decrease the scope of the intervention in a patient at an extremely high surgical risk. A combination of surgical and endovascular techniques makes it possible to minimize surgical injury, blood loss, to shorten the duration of internal organs ischaemia, to reduce the risk of paraplegia. Presented herein are the results of emergency hybrid intervention for a ruptured thoracoabdominal aortic aneurysm, accompanied and followed by description of the technical aspects of performing the surgical and endovascular stages. The early postoperative period was complicated by thrombosis of the left superficial femoral artery on the background of atherosclerotic lesions, which was successfully eliminated by means of endovascular intervention with endovascular prosthetic repair. After 10 months, the patient underwent a cardiosurgical intervention. Combining surgical and endovascular techniques made it possible in an emergency situation to save the patient's life and to provide its good quality in the remote period of follow up (4 years after the hybrid operation).

A multilevel aneurysmatic lesion of the aorta is a rare pathology. The authors describe herein a clinical case report regarding stage-wise treatment of a patient presenting with aneurysms of the thoracic and abdominal portions of the aorta and a haemodynamically significant lesion of coronary and carotid arteries. Strategy of surgical management was decided upon collegially. Successful endoprosthetic repair of the aneurysm of the thoracic portion of the aorta required closure of the left carotid artery with a graft, which, taking into consideration an existing occlusion of the right internal carotid artery, demanded preliminary carotid-subclavian bypass grafting. The clinical course of progressing angina pectoris (75% stenosis of the anterior descending artery with a poststenotic aneurysm) also increased the risk of the surgical stage. The authors provide a detailed description of the planning procedure, stages, and technical aspects of the operations performed. No complications were encountered. The duration of the follow up period amounted to 15 months. There was regression of the symptomatic manifestations, accompanied and followed by complete thrombosis of the aneurysmatic zones stented. A hybrid approach demonstrated efficacy and safety in staged treatment of complicated combined pathology of the aorta and its branches.

Objective. The aim of this prospective randomized study was to assess the impact of renal artery denervation on patients with refractory AF and drug resistant hypertension, for whom pulmonary vein isolation (PVI) was recommended. Methods. Patients with symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mm Hg despite triple drug therapy) were eligible for enrolment. 50 consenting patients were randomized to PVI only (n = 25) or PVI with renal artery denervation (n = 25). All patients were followed during 18 months to assess sinus rhythm stability and to monitor blood pressure changes. Results. Out of 25, 16 (64%) patients treated with PVI and renal denervation versus 6 (24%) of the 25 patients in the PVI-only group (p=0.004, log-rank test) were AF-free at 18-month post ablation follow-up. At the end of follow-up, significant reductions in systolic (–27±4 mm Hg) and diastolic blood pressure (–11±2 mm Hg) were observed in patients treated with PVI with renal denervation, with no significant changes in the PVI only group. Conclusion. Renal artery denervation combined with PVI reduces AF recurrence and systolic/diastolic blood pressure, as compared with conventional AF ablation, in patients with drug-resistant hypertension and AF.

Objective. The aim of this prospective randomized study was to assess the impact of renal artery denervation on patients with refractory AF and drug resistant hypertension, for whom pulmonary vein isolation (PVI) was recommended.Methods. Patients with symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure >160 mm Hg despite triple drug therapy) were eligible for enrolment. 50 consenting patients were randomized to PVI only (n = 25) or PVI with renal artery denervation (n = 25). All patients were followed during 18 months to assess sinus rhythm stability and to monitor blood pressure changes.Results. Out of 25, 16 (64%) patients treated with PVI and renal denervation versus 6 (24%) of the 25 patients in the PVI-only group (p=0.004, log-rank test) were AF-free at 18-month post ablation follow-up. At the end of follow-up, significant reductions in systolic (–27±4 mm Hg) and diastolic blood pressure (–11±2 mm Hg) were observed in patients treated with PVI with renal denervation, with no significant changes in the PVI only group. Conclusion. Renal artery denervation combined with PVI reduces AF recurrence and systolic/diastolic blood pressure, as compared with conventional AF ablation, in patients with drug-resistant hypertension and AF.

Objective. The aim of this study was to assess the impact of RD in conjunction with pulmonary vein isolation (PVI) on patients with atrial fibrillation (AF) and moderate resistant or severe resistant hypertension.Methods. The data for this study were obtained from two different prospective randomized trials and evaluated by means of meta-analysis. Patients with paroxysmal or persistent AF and moderate resistant hypertension (BP ≥140/90 mm Hg and <160/100 mm Hg; n = 60) or resistant hypertension (≥160/100 mm Hg; second study; n = 50) were randomized to PVI or PVI with RD groups and followed up during 18 months. Results. Each group had 55 patients. At 18-months, 35 (63.6%) of the 55 PVI with RD group patients were AF-free vs 22 (40%) of the 55 patients in the PVI-only group (p = 0.013; log-rank test). In patients with severe hypertension, 16 (64%) of the 25 PVI with RD group patients vs 6 (24%) of the 25 PVI-only group patients were AF-free (p = 0.004; log-rank test). For moderate hypertension, the differences were less dramatic: 16 (53.3%) of 30 vs 19 (63.3%) of 30 when RD was added (p = 0.43). Superior efficacy of adding RD was most apparent in persistent AF and resistant hypertension (probability risk 0.24 95%, confidence interval 0.08–0.69, p = 0.012). Conclusion. RD improves the outcomes of PVI, especially in patients with persistent AF and resistant hypertension.

The autonomous nervous system plays a key role in modulation of cardiac electrophysiology. Despite a great body of data on the presence of anatomic and functional relations between the nervous system and the heart, there remain a number of questions unanswered. Denervation of renal arteries or renal denervation (RDN) has become a crucial interventional technique when treating resistant arterial hypertension (AHT). Since the latter is the most prevailing cardiovascular disease complicating the course of heart rhythm disorders, atrial fibrillations in particular, it would be a good idea to study a potential value of RDN as antiarrhythmic therapy.