Treatment of a patient with acute thoracoabdominal aortic dissection complicated by haemothorax

Chernova D.V., Zherdev N.N., Chernov A.V., Kudaev Yu.A., Chernyavskiy M.A.

Research Laboratory of Vascular and Hybrid Surgery of the Research Department of Vascular and Interventional Surgery, National Almazov Medical Research Centre, RF Ministry of Public Health, Saint Petersburg, Russia

Total left-sided haemothorax is a rare and severe complication of acute DeBakey type III aortic dissection. The primary aim of treatment is immediate arrest of haemorrhage and stabilization of the haemodynamic status of the patient. Endovascular isolation of the ruptured thoracic portion of the aorta using a stent graft (TEVAR) has recently become the «gold standard» in treatment of acute, rupture-complicated aortic dissections of this localization.
Described in the article is a clinical case report concerning successful endovascular treatment of a seriously ill patient with dissection of the thoracoabdominal portion of the aorta, rupture and massive haemorrhage into the left pleural cavity. The patient underwent endoprosthetic repair of the descending aorta in the setting of a hybrid operating room under local anaesthesia, followed by drainage of the left pleural cavity. The postoperative period was uneventful with no complications. The patient was discharged in a satisfactory condition on day 10 after the emergency surgical intervention.
An important advantage of TEVAR for aortic ruptures is a minimally invasive nature of the procedure, consisting in no need to perform either sternothoracotomy or to connect a heart-lung machine, thus decreasing surgical wound, reducing the risk of perioperative life-threatening haemorrhage, and contributing to early activation of the patient.

KEY WORDS: acute dissection, DeBakey type III aortic dissection, TEVAR, aortic rupture, left-sided haemothorax.

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