This article describes a hybrid surgical technique for high-risk patients with thoraco-abdominal aortic dissections and aneurysms. The technical aspects of the first stage of surgical treatment - visceral and brachiocephalic debranching are described in detail. 17 surgical interventions for chronic dissection and aneurysm in the thoracic and thoracoabdominal aortas were performed at the Vishnevsky National Medical Research Center of Surgery of Ministry of Health of the Russian Federation in the period from 2014 to 2019. In two cases, we observed postoperative pancreatitis after surgical treatment of the abdominal aorta branches, which we managed using conservative therapy. After open surgery, all patients were discharged in a satisfactory condition. The selected technique made it possible to prepare patients for the following stage of treatment - endografting of the aorta - without developing serious complications.

This article presents a clinical observation of a patient with a giant atherosclerotic abdominal aortic aneurysm and comorbid uncorrected coronary artery disease. Taking into account the threat of aneurysm rupture, we have chosena surgical intervention using methods that reduce the risk of cardiovascular events in the perioperative period: the distal-first technique allowed us to reduce the aortic clamping time, and the use of temporary axillofemoral bypass grafting reduced peripheral resistance and stress on myocardium.