Hybrid Open-endovascular Repair Research Articles

Viabahn Open Revascularization Technique for Renal Artery Revascularization Reduces Renal Ischemia in Thoracoabdominal Aortic Aneurysm Hybrid Open-Endovascular Repair

To improve hybrid open-endovascular repair, the Viabahn Open Revascularization Technique (VORTEC) has emerged as a sutureless method that reduces renal ischemia time. This study aimed to compare the differences between VORTEC and standard hybrid open-endovascular repair of thoracoabdominal aortic aneurysm (TAAA) in renal ischemia. This is a retrospective analysis of 26 TAAA patients who underwent hybrid open-endovascular repair from April 2005 to April 2017. Twenty-one patients underwent standard hybrid open-endovascular repair, and 5 underwent VORTEC hybrid open-endovascular repair. Through April 2018, 26 patients were followed up for 48±43months. Nine patent renal arteries were revascularized by Viabahn in the VORTEC group, while 36 were revascularized with presewn multibranched grafts in the standard treatment group. The renal ischemia time was shorter in the VORTEC group than in the standard treatment group (5±2min vs. 15±6min). The increase in serum creatinine (SCr) on the first postoperative day in the standard treatment group was higher than that in the VORTEC group (1.68±0.79 vs. 1.14±0.05). Acute kidney injury (AKI) occurred in 5 patients in the standard treatment group (5/21, 24%). No patient experienced AKI in the VORTEC group (0/5, 0%). The renal artery (RA) patency rates in the VORTEC group were 100% (7/7) at both 1week and 12months after surgery. In the standard treatment group, the RA patency rates were 97% at 1week (33/34) and 93% at 12months (28/30) after surgery. VORTEC reduces renal ischemia time and decreases postoperative AKI in patients undergoing hybrid repair of thoracoabdominal aneurysms.

Postoperative Outcomes of Complex Aortic Aneurysm Repair Using Hybrid Open-Endovascular Techniques

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.

Two-stage hybrid open-endovascular repair of a Crawford type IV aortic aneurysm: therapeutic challenge

We present a case of a patient with Crawford type IV aortic thoracoabdominal aneurysm. The patient underwent hybrid repair in two stages. Initially a Dacron(r) graft was implanted surgically with revascularization of all visceral branches from the left external iliac artery (debranching). On a later date, the second stage of treatment was with an endovascular technique with bi aorto-iliac endoprosthesis. After 2 years the patient remains asymptomatic and in full working activity.

Reversed Sequence Arch Debranching for Treatment of a Ruptured Juxta-Innominate Artery Saccular Aneurysm

To describe a hybrid approach for the treatment of a ruptured juxta-innominate artery saccular aneurysm. A 68-year-old smoker male with poor exercise tolerance sustained a contained ruptured saccular aneurysm at the origin of the innominate artery. Although under the femoral-axillary bypass to allow direct brain perfusion, a 36 × 110 mm thoracic endograft was successfully deployed with total coverage of the distal ascending and aortic arch. A sternotomy was performed and an aorto-innominate and left common carotid artery bypass was done. At 1-month follow-up, a type 2 endoleak at the innominate artery stump was noted and successfully treated with coil embolization. The patient remains neurologically intact 1 year after the surgery. Juxta-innominate artery saccular aneurysms are rare. A hybrid open-endovascular repair using a reversed sequence arch debranching after endovascular repair is feasible and may be an alternative to deep hypothermic circulatory arrest particularly in frail patients.

Eight-Year Follow-Up of a High-Risk Patient Treated for Crawford Type II Thoracoabdominal Aortic Aneurysm (TAAA) with a Multistage Hybrid Open-Endovascular Repair

The case of a patient with type II TAAA (thoracoabdominal aortic aneurysm), who underwent multistage hybrid procedure, is presented. This high-risk patient was excluded as ineligible for conventional open repair. At first, the bypass between both common carotid arteries was inserted. Then, the transperitoneal viscerorenal revascularization was performed to ensure blood perfusion. At the end, the stent graft from the aorta arch to its bifurcation was deployed with endovascular techniques. This stent graft covered left common carotid artery, left subclavian artery, visceral trunk, superior mesenteric artery and both renal arteries. The patient had been observed for eight years with relatively low complication rate. The hybrid open-endovascular repair (HOER) shows promising results in patients at prohibitive risk for classic reconstruction.

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

Many authors using a hybrid debranching strategy for the treatment of thoracoabdominal pathologies have reported disappointing results and the initial enthusiasm for the technique has given way to criticism and ambiguity. The aim of the present meta-analysis study was to assess the safety and efficacy of the technique in patients with thoracoabdominal aortic aneurysms or other aortic pathologies. A multiple electronic search was performed on all articles describing hybrid open endovascular repair. Separate meta-analyses were conducted for technical success, visceral graft patency, spinal cord ischemia symptoms, renal insufficiency, and other complications as well as 30-day/in-hospital mortality. Nineteen publications with a total of 507 patients were analyzed. The pooled estimates for primary technical success and visceral graft patency were 96.2% (95% CI, 93.5%-98.2%) and 96.5% (95% CI, 95.2%-97.8%) respectively. A pooled rate of 7.5% (95% CI, 5.0%-11.0%) for overall spinal cord ischemia symptoms was observed; whereas for irreversible paraplegia the pooled rate was 4.5% (95% CI, 2.5%-7.0%). The pooled estimate for renal failure was 8.8% (95% CI, 3.9%-15.5%). The pooled 30-day/in-hospital mortality rate was 12.8% (95% CI, 8.6%-17.0%). During the mean follow-up period of 34.5 (95% CI, 31.5-37.5) months, a total of 119 endoleaks were identified in 111 patients (22.7%). The repair of thoracoabdominal pathologies by means of hybrid procedures in patients who are poor surgical candidates is still associated with significant morbidity and mortality rates. Future studies may substantiate whether the technique is amenable to amelioration and improvement.

Hybrid open-endovascular repair of a contained suprarenal mycotic aneurysm using femoral vein

Mycotic aneurysms have a high mortality rate, predominantly driven by sepsis. We present a 61-year-old patient who was treated with a hybrid open-endovascular repair using autologous femoral vein as a single channel revascularization. This provided a practical and innovative approach to a high-risk situation.

Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms:

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.

Hybrid Open Endovascular Repair of Para-Anastomotic Common Iliac Artery Aneurysm in the Presence of Bilateral External Iliac Artery Occlusions

We describe a successful hybrid open endovascular repair of a large tender para-anastomotic common iliac artery aneurysm arising after previous open abdominal aortic aneurysm repair in a high-risk patient with bilateral chronic total external iliac artery occlusions.

Hybrid Open-endovascular Repair for Thoracoabdominal Aortic Aneurysms: Current Status and Level of Evidence

Hybrid Open-endovascular Repair for Thoracoabdominal Aortic Aneurysms: Current Status and Level of Evidence