Hybrid Repair Of Aortic Aneurysm Research Articles

Hybrid repair of aortic aneurysm in patients with previous coarctation

Hybrid operations combining open and endovascular techniques have evolved for patients with complex aortic and coexisting cardiovascular disease. Our objectives were to describe the repair techniques and assess the outcomes in patients undergoing hybrid repair for aneurysm associated with previous aortic coarctation. From 2004 to 2012, 14 patients underwent hybrid repair by elephant trunk with endovascular completion (n=5), frozen elephant trunk (n=8), or antegrade stent grafting (n=1). The mean age at surgery was 45 ± 13.5 years. Of the 14 patients, 8 underwent supra-aortic arterial revascularization (ascending to subclavian bypass in 5, carotid-subclavian bypass in 2, or ascending to carotid and subclavian bypass in 1). Ten patients had a bicuspid aortic valve, 5 underwent concomitant aortic valve replacement, and 1 underwent valve repair. Six had a hypoplastic arch. Other procedures included ascending aortic repair (n=4), coronary artery bypass grafting (n=1), ascending to descending bypass (n=1), and subclavian aneurysm repair (n=1). One operation was an emergency, the others were elective. The mean maximum aneurysm diameter was 5.9 ± 1.5 cm. Data were obtained from a prospective database and chart review. No perioperative mortality, stroke, renal failure, or paraplegia occurred. One patient required prolonged intubation, another required reoperation for postoperative bleeding. Two endoleaks required repeat intervention. The mean length of stay was 9 ± 5.5 days. One late death occurred from hypertensive crisis and associated disseminated intravascular coagulation. At a mean follow-up of 26 months, no aortic growth was found. Hybrid repair of postcoarctation repair aneurysm is a safe and effective, less-invasive treatment option for patients with complex anatomy and/or concomitant cardiac disease.

Hybrid Repair of Aortic Aneurysms Involving the Visceral and Renal Vessels

Hybrid Repair of Aortic Aneurysms Involving the Visceral and Renal Vessels

Hybrid Repair of Aortic Aneurysms Involving the Visceral and Renal Vessels

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.