CT16 HYBRID OPEN AND ENDOVASCULAR PROCEDURES FOR COMPLEX AORTIC PATHOLOGY IN THE HIGH‐RISK SURGICAL PATIENT

Abstract

Purpose The management algorithm for the complex aorta in the high‐risk patient continues to evolve, especially given increasing applicability of endovascular solutions to these cases. We present three examples of aortic pathology managed in a staged fashion utilising hybrid open/endovascular techniques, as alternatives to classic aortic procedures.Methodology Hybrid open/endovascular procedures were employed in three select cases. All patients underwent an open aortic “debranching” procedure, in which some of the cervical/thoracic/abdominal aortic branches were relocated, to permit subsequent insertion of an endoluminal prosthesis while preserving end‐organ perfusion. The stent‐graft was inserted as a separate procedure.Results All patients were males aged over seventy‐five years. Two patients presented with saccular aneurysms of the mid‐distal aortic arch, whereas the third patient had a Crawford type I thoracoabdominal aortic aneurysm associated with chronic dissection. The left common carotid/subclavian arteries were relocated in all three patients, as were the major abdominal visceral vessels in the patient with thoracoabdominal disease. Endoluminal stent‐grafts were placed into the relevant portion of the aorta in all patients. Stent‐graft placement was successful in all cases, with radiologically confirmed exclusion of the relevant aortic pathology. There was no mortality and no significant morbidity.Conclusion Patients considered to be at high risk for thoracic/thoracoabdominal open aortic surgery may be suitable for an endovascular management strategy, although an accompanying surgical debranching procedure may be required to facilitate the subsequent appropriate placement of a stent‐graft.