การรักษาโรคหลอดเลือดแดงใหญ่แบบผสมผสาน

The aorta is the body’s largest artery and plays a critical role in delivering oxygen-rich blood from the heart to major organs, including the brain, spinal cord, arms, legs, liver, kidneys, and intestines. When this vital vessel becomes dilated or ruptures, the condition can be life-threatening, with a mortality rate as high as 50–90%.
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<h2>Understanding the Aorta</h2>
The aorta originates from the heart and extends down to the abdomen near the level of the navel. In some patients, abnormalities may be found in multiple segments of the aorta, with various underlying causes. This makes strategic treatment planning essential to ensuring the patient’s safety.
In general, physicians prioritize treating the portion of the aorta nearest to the heart or the area that is at immediate risk of rupture—typically the symptomatic or largest segment.
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<h2>Imaging and Diagnosis</h2>
CT angiography provides a comprehensive view of the aorta’s anatomy and pathology. Based on the imaging results, physicians may recommend either a single-stage treatment (addressing all affected segments at once) or a staged approach based on clinical priorities.
Some aortic segments can be successfully treated with endovascular stent grafts, while other areas may require open surgery for optimal outcomes. Therefore, a hybrid approach combining both techniques, carefully sequenced, can maximize safety and treatment effectiveness.
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<h2>Case Example: Hybrid Aortic Repair</h2>
A 69-year-old female patient presented with severe back pain and a long-standing history of hypertension. CT angiography revealed a dissecting thoracic aortic aneurysm extending from the descending thoracic aorta into the abdominal region. Additionally, a 5.3 cm infrarenal abdominal aortic aneurysm was identified.
Coronary angiography showed normal heart vessels, and renal function was preserved. The treatment plan began with endovascular stent graft placement through the left groin to repair the thoracic aorta. This led to significant relief of back pain.
However, the patient subsequently experienced severe abdominal pain. Further evaluation indicated the need for open abdominal aortic replacement using a prosthetic graft, performed via a midline abdominal incision.
Open surgery was chosen for the abdominal aneurysm because the dissected aortic wall below the renal arteries was unsuitable for endovascular repair.
The second procedure was performed on Day 3 following the initial endovascular treatment. The surgery was successful, and the patient was discharged 7 days later. Postoperative CT scans showed organized thrombus formation in the thoracic aorta, reducing the risk of rupture. Blood flow to the abdominal organs returned to normal, and the abdominal pain resolved completely.
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<h2>Safe and Effective Hybrid Treatment</h2>
In cases of complex aortic disease involving multiple levels of pathology, hybrid treatment—a combination of endovascular and open surgical techniques—offers a safe and effective solution with minimal complications. With meticulous planning and proper treatment sequencing, patients can achieve excellent outcomes and reduced procedural risk.
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The aorta is the body’s largest artery and plays a critical role in delivering oxygen-rich blood from the heart to major organs, including the brain, spinal cord, arms, legs, liver, kidneys, and intestines.

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Hybrid Treatment for Aortic Disease: A Safe and Effective Approach

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