Staged and hybrid approach in the treatment of complex aortic dissection

Multilevel aortic disease presents a formidable challenge for vascular surgeons. In the past,multilevel aortic surgery was performed simultaneously or subsequently. Single-stage intervention is thought to be associated with a high incidence of complications, and sequential repair requires several major surgical interventions. The rupture of residual lesion, however, may take place while waiting the second operation. Endovascular treatment is recognized as a viable alternative to the treatment of the diseased aortic areas especially in the high-risk patient, as it could markedly lower the incidence of complications compared with other procedures. However, thoracic aortic anatomy must be favorable to the placement of a stent-grafi （SG）. Sufficient proximal and distal landing zone is mandatory to deploy the SG and ensure a satisfactory exclusion result. Therefore, complex dissection with multiple-tear located extremely near the orifice of the visceral arteries is excluded from orthodox endovascular therapy. Here we present a case of multi-teared dissecting aneurysm treated by a four-staged hybrid surgery with placement of 5 SGs.