Hybrid endovascular aorta repair with simultaneous supra-aortic branch or iliac branch revascularization.
OBJECTIVE
To describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta.


METHODS
From June 2007 to May 2008, 5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique. Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft. Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type III aortic dissection case. The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft, then total aortic arch and descending artery was occluded with stent-graft. The left carotid artery to the left subclavian artery bypass was created in 1 case, followed by stent-graft deployment. Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route, then hybrid procedure was performed with bifurcated stent-graft. All stent grafts were deployed via a retrograde femoral artery approach in 5 patients.


RESULTS
Technical success with complete aneurysmal exclusion was achieved in all patients. There was no incidence of endoleak. During a follow-up period of 2 to 10 months, documented perioperative neurologic events did not occur in all patients. One patient suffered from adult respiratory distress syndrome. After received tracheostomy, he recovered later. There was one death resulting from a postoperative myocardial infarction.


CONCLUSIONS
Hybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.
Zheng
Yue-Hong
YH
Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Choi
Nim
N
Deng
Hong-Ru
HR
Kouk
Cu
C
Yu
Kun
K
Rui
Furtado
F
D000368:Aged; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*