Hybrid Debranching With Endovascular Repair for Thoracoabdominal Aneurysms: A Comparison With Open Repair

Abstract

Hybrid visceral-renal debranching procedures with endovascular repair have recently been proposed as a less invasive alternative to conventional thoracoabdominal aortic aneurysm (TAAA) surgery. This study provides a concurrent assessment of hybrid and open TAAA repair. One hundred two consecutive patients (mean age, 63.0 years) underwent open (73) or hybrid (29) Crawford type 1 (19), 2 (50), or 3 (33) TAAA repair from 2000 to 2009. Hybrid debranching procedures were selected for patients considered poor operative risk for standard TAAA repair (27) or for patient preference (2). The TAAAs were fusiform atherosclerotic (68), dissection (30), or pseudoaneurysm (4). Fifty-seven patients (55.9%) had previously undergone aortic repair. Outcomes were analyzed with 100% follow-up (mean, 30.5 months). Operative procedures were urgent or emergent in 16 (15.6%). Early mortality occurred in 13 (12.7%), and was independently predicted by use of hypothermic circulatory arrest (p = 0.005). Early morbidity included permanent paraplegia (12), stroke (1), need for dialysis (22), or tracheostomy (7). Independent correlates of a composite outcome comprised of early mortality and these early morbidities included an urgent-emergent presentation (p = 0.002) or open TAAA repair (p = 0.021). Kaplan-Meier survival was similar between open and hybrid TAAA groups (p = 0.88). Late mortality was independently predicted by the presence of diabetes (p = 0.052) or the need for dialysis at the time of TAAA repair (p < 0.001). Hybrid debranching procedures may reduce early morbidity and yield similar late survival, even in a group considered high risk for open surgery. These data support the increasing utilization of a hybrid debranching and endovascular approach for patients requiring thoracoabdominal aneurysmectomy.