Outcome of hybrid visceral debranching endovascular aortic repair

Abstract

Objective The aim was to study the outcomes of hybrid debranching endovascular aortic repair (H-EVAR) for thoracoabdominal aortic aneurysm. Patients and methods Patients who had H-EVAR for treatment of thoracoabdominal aortic aneurysm between January 2010 and December 2018 were included in this study. Early outcome (30 days) in terms of mortality, morbidity, and target vessel patency were analyzed. Follow-up outcomes in terms of late death, endoleak, and re-intervention rates were evaluated. Results A total of 33 patients (48% males) with a mean age of 68±13 years were included. Eighteen (55%) patients were asymptomatic, whereas eight (24%) patients were symptomatic and seven (21%) patients had a contained rupture. Six (18%) patients died after the visceral debranching operation (stage 1), and 27 (82%) patients completed both stages of H-EVAR. The 30-day mortality in completed H-EVAR was 5 (19%) of 27 patients. Five (15%) patients developed spinal cord ischemia. Four (12%) patients had post-operative dialysis. Two (6%) patients had a stroke. Four (12%) patients experienced respiratory failure. Four (12%) patients had mesenteric ischemia and two (6%) had ischemic colitis. The 30-day overall primary target vessel patency rate was 92±3%. Early endoleak I rate was 3 (11%) of 27 patients, and endoleak III rate was 2 (7%) of 27 patients (completed H-EVAR). The mean follow-up period was 23±11 months for 22 patients who survived the completed H-EVAR. Late death occurred in 4 (18%) of 22 patients. Conclusion Hybrid EVAR had several advantages that included avoiding thoracotomy, aortic cross-clamping, single-lung ventilation, and the need for extensive dissection in multiple aortic segments. However, the controversial outcomes led to criticism, and there is a need to examine the three techniques (open, hybrid, and total endovascular) simultaneously, which would give a unique definition of the selection criteria to achieve the optimum results in each patient.