Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms:

Abstract

To summarize the existing evidence on the use of hybrid open/endovascular repair in patients with thoracoabdominal aortic aneurysms (TAAA). A thorough search was performed of the English-language literature published between January 1999 and October 2008. Studies that reported the results of hybrid procedures as the intended repair strategy in patients with TAAAs were selected using specific inclusion criteria [TAAA diagnosis based on the modified Crawford classification, a minimum 1-month follow-up, and data available on patient demographics, technical success, 30-day mortality, follow-up length, and outcome (neurological deficit, renal impairment, and/or graft vessel patency)]. From 35 articles initially identified, 15 studies were included in the statistical analysis encompassing 108 patients (75 men; mean age 67.6 years) with TAAAs averaging 72.7 mm in diameter. The majority of patients had aneurysms classified as Crawford types I (n = 20), II (n = 39), or III (n = 29); there were 14 type IV and 6 type V. Technical success was achieved in 91.6% (n = 99) of the 108 patients. Nineteen (16.6%) primary endoleaks and 3 (2.7%) secondary endoleaks were reported. Elective 30-day mortality was 10.4% (n = 10), while total 30-day mortality, including emergency cases, was 14.8% (n = 16). Three (2.7%) patients developed some permanent neurological deficit; renal failure was reported in 12 (11.1%). The mean follow-up period was 10.6 months, during which 97% of the grafts remained patent. Overall follow-up mortality was 24.1% (n = 26). Hybrid open endovascular repair is a new therapeutic option with encouraging results for patients considered unfit for conventional open repair. However, further research is required to draw robust conclusions.