Surgical prostheses made of Dacron have been widely used in cardiovascular surgery for decades with proven reliability and excellent reputation for long-term endurance. Nevertheless, an extremely rare complication, namely late non-anastomotic graft rupture, due to intrinsic structural prosthetic disruption can occur. We present herein a clinical case report concerning successful endovascular treatment of a patient with non-anastomotic rupture of a bifurcated graft implanted 18 years ago for an infrarenal aortic aneurysm.

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.

Transcatheter implanting of aortic valve (TIAV) in critical aortic stenosis is a separate manipulation requiring thorough preparation. Among patients with critical aortic stenosis from a group of endovascular correction, there is a high prevalence of comorbid atherosclerotic lesions in coronary, carotid arteries, and other pathologies, manageable only interventionally.Aim. To assess the efficacy and safety of single-moment performing of TIAV and additional endovascular interventions.Material and methods. From the year 2011, in our clinic endovascular implanting of aortic valve was done for 125 patients with aortic valve dysfunction, in 51% (64 patients) had coronary, renal and carotid arteries lesion, aneurysmatic dilation of abdominal aorta. In 31 (48%) cases together with endovascular valve placement additionally endovascular interventions were done.Results. Technical success was reached in all 125 cases. In-patient mortality from all causes was 7.2% (9 patients), with no significant difference between combination treatment group and other patients. In 2 cases there was stenting done, of coronary and carotid arteries (with 1 case of coronary, carotid and renal arteries), as single step. In one patient there was endovascular prevention done of ischemic complications of permanent atrial fibrillation by implanting of the system Watchman (Boston Scientific, USA) and stenting of coronary arteries; in one case a single step endoprosthesing of abdominal aorta was done and coronary stenting. In concomitant interventions group there was no myocardial infarction and no significant difference in cerebrovascular events between groups.Conclusion. TIAV can be followed by single step addition of endovascular procedures if the surgical team and clinics has good experience, and with thorough planning of operation and post-surgery period.