Is Hybrid Procedure the Best Treatment Option for Thoraco-Abdominal Aortic Aneurysm?

R. Chiesa, Y. Tshomba, G. Melissano, D. Logaldo

Research output: Contribution to journalArticle

Abstract

Objective: Hybrid thoraco-abdominal aortic aneurysm (TAAA) repair, consisting in re-routing of abdominal aortic visceral branches followed by TAAA endograft exclusion has been shown to be a feasible strategy, especially appealing in high-risk patients. Patients and methods: We analysed 31 high-risk patients who underwent hybrid TAAA repair in our centre with a variety of visceral re-routing configuration and of commercially available thoracic endografts. Twenty-three simultaneous (74.2%) and eight staged procedures (25.8%) were performed with a four-vessel re-vascularisation in 10 cases (32.3%), a three-vessel in six (19.4%) and a two-vessel in 15 (48.4%). We also performed a literature review of major single-centre series of TAAA hybrid repair. Results: No intra-operative deaths were observed in our series, with a technical success in endovascular TAAA repair of 100%, an overall perioperative mortality of 19.4% and a perioperative morbidity of 35.5%, including one case (3.2%) of permanent paraplegia. At a median follow-up of 11.9 months, we observed a visceral graft occlusion rate of 6.8%, one type II endoleak and one endograft migration. From the literature review, six other single-centre series with more than 10 hybrid TAAA repairs were found. From data available of 107 patients, we observed a mean perioperative mortality of 15.6%, the rate of primary endoleaks was 17.9%, paraplegia/paraparesis 7.2% and renal failure 9.9%, with other major perioperative complications reported in the 50.6% of cases. At the follow-up period visceral graft occlusion rate was 5.1%. Conclusion: Typical complications of conventional TAAA open surgery have been not eliminated by hybrid repair and significant mortality and morbidity have been reported till date. The fate of visceral bypasses and incidence of endoleak and other endograft-related complications need to be carefully assessed. Hybrid TAAA repair should nowadays be limited as alternative to simple observation in patients unfit for the conventional open repair.

Original languageEnglish
Pages (from-to)26-34
Number of pages9
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume38
Issue number1
DOIs
Publication statusPublished - Jul 2009

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Fingerprint Dive into the research topics of 'Is Hybrid Procedure the Best Treatment Option for Thoraco-Abdominal Aortic Aneurysm?'. Together they form a unique fingerprint.

Cite this