Six complex emergency operations in four consecutive days were performed by vascular surgeons at ‘Heart and Brain’

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The life-saving approach applied is unique for Bulgaria and the world

Six complex operations, three of which were performed on an emergency basis using the method of a customized and physiologically modeled prosthesis, were performed by vascular surgeons at ‘Heart and Brain’, Pleven. “The technique is extremely complex and specific. Literally on the fingers of the hand are counted the hospital centers in the world that have successfully implemented this type of surgery in a state of emergency,” informed Dr. Todor Samardzhiev, head of the department of vascular surgery at the high-tech hospital. The operated patients were admitted to Pleven from other hospitals in the country. Although transportation carries an additional risk, the survival rate of patients with ruptured aneurysms increases when they are treated in a hospital where the necessary specialists and equipment are available.”

“Five of the interventions we had to do in a very short time were on patients with abdominal aortic aneurysm, three of them with rupture (rupture). The sixth was on a patient with a renal artery aneurysm. These conditions are some of the most life-threatening, and rupture requires immediate measures because it involves the effusion of a large amount of blood into the abdominal cavity. The only treatment is surgical intervention. Any delay could be fatal for the patient, and the risk of a fatal outcome in classic open surgery for a ruptured aneurysm is over 90%.”

Endovascular aortic aneurysm repair (EVAR) is routinely performed at ‘Heart and Brain’, Pleven, both in elective and emergency patients. The challenge in these three cases was that the nature of the aneurysm did not allow standard endovascular surgery. Therefore, in three of the cases we inserted a customized and physiologically modeled prosthesis. An extremely complex method, requiring impeccable precision, team preparation and technique,” explains Dr. Samardzhiev.

The condition of the patients necessitated the placement of a fenestrated endoprosthesis. Fenestrations are openings in endoprostheses through which vital organs are supplied with blood. However, such prostheses are not available in the country and their cost exceeds BGN 70 000. “Making a ready-made custom prosthesis would take a lot of time and money. We have successfully modified an existing graft, which is covered by the NHIF,” says the head of vascular surgery. The multidisciplinary team decided to apply the approach, which is new for our country and was first successfully implemented in ‘Heart and Brain’ half a year ago. Through precise measurements and calculations, the vascular surgeons modify the implant for the patient’s specific needs by 3D imaging in a sterile environment. This is followed by an extremely delicate process of placing stents in the renal and iliac arteries. The surgery is minimally invasive and requires careful advance preparation, a great deal of knowledge and additional skill on the part of the physicians.

“We did all the surgeries as per the global time requirements – from the entry into the room, anaesthesia to the intervention itself. The aneurysms were asymptomatic and the only thing the patient could feel as a kind of warning was pulsations in the abdominal area, but no pain. The appearance of sharp and sharp pain is already a sign of rupture and a state of emergency. Unfortunately, the hospitals in the country where these emergency conditions can be operated are still few,” the experts add.

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