Hybrid Repair of Aortic Aneurysms Involving the Visceral and Renal Vessels

Abstract

We sought to analyze our experience with hybrid treatment of aortic aneurysms involving the renal and visceral arteries. We conducted a retrospective review of 36 consecutive patients who underwent renal/visceral bypasses followed by aortic endografting. Patient demographics, medical history, operations, complications, graft patency, and patient survival were recorded. Observational and comparative analyses were performed. Mean patient age was 71 years. Mean aneurysm diameter was 6.3 cm (range 4.1-9.4 cm). Crawford aneurysm types included 1 type I, 10 type II, 12 type III, 10 type IV, and 3 pararenal aneurysms. Four patients were symptomatic. One hundred twenty-three bypasses were performed (median of three per patient), including 62 renal, 32 superior mesenteric, and 29 celiac arteries. Retrograde inflow (using the iliac arteries, aorta, or a limb of an aortobifemoral graft) was obtained in 30 patients and antegrade inflow was performed in six (three from the supraceliac aorta and three celiac branch to renal bypasses). In-hospital mortality occurred in 3 patients (8.3%). Patient survival was 80% at a mean follow-up of 6 months. Major morbidity occurred in 17 patients (47%) and included need for dialysis (5), ischemic colitis (3), failure to thrive (5), temporary paraparesis (1), and need for reoperation (7). No patient sustained permanent paraplegia. Mean length of stay was 26 days (range 8-100 days). Primary renovisceral bypass graft patency rate at 8 months was 93%. During follow-up, 14 patients developed at least one endoleak, 2 patients required percutaneous intervention, and the rest remained under observation. At last follow-up, four type 2 endoleaks and one type 3 endoleak with stable or decreasing aneurysm size. Hybrid repair of aortic aneurysms involving the renal and visceral arteries is feasible with a reasonable mortality and satisfactory short-term visceral graft patency rate. However, the morbidity of the debranching procedures is high. More stringent patient selection may improve these results.