Abstract
Aortic disease becomes more prevalent with age and can result in acute aortic conditions including aneurysm, dissection, intramural hematoma and penetrating ulcers. Repair techniques for these conditions remain controversial due to the varying outcomes of studies. This retrospective study collected and analyzed data from twenty-three (23) patients with complex aortic aneurysms repaired using hybrid open-endovascular techniques. A high percentage of patients (82.6%) suffered from multiple comorbidities, including hypertension, hyperlipidemia, renal disease, coronary artery disease, congestive heart failure and prior aortic procedures. All patients presented with ASA scores 3 or 4. Eleven patients (47.8%) presented with aneurysms of the ascending, transverse and descending arch, and seven patients (30.4%) with thoracoabdominal aneurysm. 78.3% of patients underwent thoracic vessel debranching, while the remainder underwent visceral vessel debranching (13.0%) or thoracic and visceral debranching (8.7%). No patients suffered visceral ischemia, spinal cord injury, extremity amputation or reoperation for bleeding post-operatively. Two patients suffered minor stroke (8.7%) and one patient (4.3%) had major stroke. Three patients (13.0%) suffered temporary kidney injury and one patient (4.3%) developed renal failure requiring dialysis. Four patients (17.4%) developed Type II stent graft endoleaks. All patients had patent grafts. Reintervention occurred in two patients (8.7%). Thirty-day mortality occurred in three patients (13.0%). These results are within the range reported in other studies involving hybrid repair of aortic conditions, and show that hybrid open-endovascular repair is a feasible alternative in high-risk patients.
Highlights
The prevalence of aortic disease increases with age due to many factors, including higher oxidative stress, endothelial dysfunction and arterial wall changes [1]
Hybrid repair has been increasingly used as an alternative to open repair techniques since the procedure was first described in 1999 [3,4,5]
Patients in this study had a wide range of aortic disease (Table 2), which is expected as the degenerative state of the aorta is a systemic and widespread pathology
Summary
The prevalence of aortic disease increases with age due to many factors, including higher oxidative stress, endothelial dysfunction and arterial wall changes [1]. The most emergent and acute forms of the diseases include aneurysm, aortic dissection, aortic intramural hematoma and aortic penetrating ulcers. Open repair of aortic aneurysm has historically high rates of morbidity and mortality [2], necessitating the development of alternative practices, especially in complex aneurysms. Hybrid repair has been increasingly used as an alternative to open repair techniques since the procedure was first described in 1999 [3,4,5]. Hybrid repair involves debranching of the aortic arch and/or of the visceral or renal vessels, followed by supra aortic and visceral revascularization, relining of the diseased aortic region with stent grafts [6]. The appeal of the hybrid approach (depending on aneurysm location) includes avoidance of pleural or double cavity invasion, hypothermic cardiac arrest and prolonged aortic cross-clamping [7,8]
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