Kerala Man's Life Saved by Innovative Hybrid Aortic Aneurysm Procedure
When a man in his early sixties from Kerala arrived at the hospital complaining of severe mid-back pain, medical staff immediately recognized this was no ordinary case. The patient had a complex medical history that included long-standing high blood pressure, a heavy smoking habit, and significant lung damage from a previous tuberculosis infection. Even on normal days, breathing was a challenge for him.
What began as back pain soon revealed a much more serious underlying condition. A routine chest X-ray showed concerning signs of a widened aortic arch, prompting further investigation. A subsequent CT scan confirmed the alarming diagnosis: a large Zone 2 arch aortic aneurysm.
The Dangerous Diagnosis
An aortic aneurysm represents a dangerous ballooning and weakening of the body's main blood vessel. When located in the Zone 2 arch area—one of the most complex regions near the heart—the risk becomes particularly severe. A rupture at this location could prove fatal within mere minutes, making immediate intervention crucial.
However, traditional surgical approaches presented their own dangers for this particular patient. His compromised lung function and active chest infection meant that conventional open-heart surgery carried enormous risks, including prolonged ventilation requirements, potential stroke, and even mortality.
A Creative Surgical Solution
Zone 2 arch aneurysms present unique challenges because the aorta in this region supplies major blood vessels to the brain. Any surgical misstep could compromise blood flow to the head and neck, with devastating consequences. For this patient, traditional surgery involving wide chest opening and aortic replacement was simply not feasible given his pulmonary limitations.
The medical team, led by Dr. Rohit P V Nair, Senior Consultant in Vascular and Interventional Radiology, devised an innovative two-stage hybrid approach that combined surgical and endovascular techniques.
The Staged Procedure
The first stage involved arch debranching and aortic banding. Surgeons carefully rerouted the blood vessels supplying the brain and upper body, creating alternative pathways to ensure uninterrupted cerebral blood flow. They then placed a surgical band around the ascending aorta to establish a stable landing zone for the subsequent stent graft placement.
Following recovery from this initial procedure, the team proceeded with the second stage: Thoracic Endovascular Aortic Repair (TEVAR). Rather than reopening the chest, doctors inserted a 36 mm thoracic stent graft using the Terumo Relay Pro system, guiding it precisely into position through the blood vessels. The graft was deployed approximately 10 mm above the debranching site, effectively sealing off the weakened, ballooned section of the artery.
This innovative approach successfully excluded the aneurysm sac from blood flow, relieving the dangerous pressure that had been building within the vessel.
Challenging Recovery and Positive Outcome
The surgical intervention proceeded according to plan, with immediate relief from the patient's debilitating back pain. However, recovery proved challenging due to his pre-existing pulmonary complications. He required approximately four days in the intensive care unit followed by ten additional days in the general ward, totaling three to four weeks of hospitalization.
Follow-up CT scans provided reassuring results: the stent graft remained properly positioned, the aneurysm had been successfully excluded, and blood flow to the brain and other major vessels continued unimpeded. Although doctors noted a mild inner curve endoleak—a small amount of blood flow around the graft—they anticipate this will seal naturally over time.
Broader Implications for High-Risk Patients
This case demonstrates how coordinated planning and innovative technique combinations can successfully manage even the most complex and high-risk medical scenarios. Patients with aortic arch aneurysms and significant comorbidities often face limited treatment options, with many being deemed inoperable through conventional approaches.
The hybrid procedure represents a viable alternative for such challenging cases, requiring seamless coordination between surgical and endovascular teams but offering life-saving potential where few other options exist.
The patient has since returned home to Kerala, where he continues his recovery journey. His medical team emphasizes the importance of ongoing lung care, strict blood pressure management, and complete smoking cessation for his long-term health.
This medical success story underscores how contemporary medicine increasingly focuses on tailoring approaches to individual patient needs, sometimes choosing less dramatic but safer pathways that make all the difference in patient outcomes.
