Guwahati: In a rare medical feat for India’s Northeast region, an emergency life-saving procedure was performed by an expert panel of doctors at Guwahati’s Excelcare Hospitals on a 43-year-old man from Sikkim, who presented with serious complications related to ‘Type B Aortic Dissection’.

The procedure was performed by Major General Dr Kamal Pathak (Senior Interventional Radiologist), assisted by the cardiology, cardiovascular surgery and anaesthesiology team, registering it as the first recorded instance of such a case ever treated in the Northeast.

Dr Pathak said the patient had initially gone to Kolkata for treatment of a renal problem, but upon screening and investigation, was diagnosed to have Type B Aortic Dissection.

Aortic dissection is a serious cardiac condition in which the blood flows into the layers of the aorta and causes a false and true lumen. The false lumen compresses the true lumen and compromises the blood supply to the vital organs of the body. If untreated, this false lumen can grow in size and rupture, causing the death of the patient.

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Given the complexity of the case, the patient was immediately referred to Excelcare Hospitals from Kolkata for further treatment. There, the team of cardiac surgeons and cardiologists placed a stent graft across the entry point of the dissection.

“As the patient had a dominant left vertebral artery supplying the posterior part of the brain, a fenestration (hole) was made in the stent graft, matched with the origin of the subclavian artery and a covered stent used to bridge this gap,” said the doctor.

Dr Pathak said the aorta is the body’s main artery, which branches off the heart and descends in the thorax and into the abdomen. A dissection of the aorta occurs when a tear develops within its wall. The wall consists of three layers and this tear allows blood to flow in between the inner and middle layers, causing them to separate or dissect.

Aortic dissections are classified into two types: type B dissection involves a tear in the descending part of the aorta and may extend into the abdomen, whereas type A dissection develops in the ascending part of the aorta just as it branches off the heart.

Dr Neil Bardoloi (Chief Cardiologist) said this was the first instance of an on table fenestration Thoracic Endovascular Aortic Repair (TEVAR) having been performed in Northeast India. The procedure requires specialised endovascular skills and finesse. The most serious complication is the rupture of the aorta, which can cause severe internal bleeding and lead to death.

“It is done by very few operators in the country and Maj Gen (Dr) Kamal Pathak is one of them. Post-procedure, the patient was stable and has made good recovery. The patient has now been discharged,” said Dr Neil.

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