Combined open and endovascular treatment of thoracoabdominal aneurysms and secondary expanding aortic dissections: early and mid-term results from a single-center series.
BACKGROUND
We present a review of our experience with combined surgical therapy with endovascular stent repair and conventional revascularization of the supraaortic and/or visceral/renal arteries (hybrid procedure) in the treatment of thoracoabdominal aortic aneurysms and dissections.


METHODS
We followed 20 patients (7 women, median age 58.3 years, age range 37-68 years) prospectively. Severe comorbidity was present in 7 patients, 13 patients had previous aortic surgery. The median diameter of the thoracoabdominal aneurysm was 74.4 mm (Crawford I, 1 patient; II, 11; III, 7; V, 1), and 13 patients had previous aortic surgery. After visceral and renal revascularization, three stent grafts were implanted on average. Follow-up examination was every 6 months. The median follow-up was 174.5 days (15-375 days).


RESULTS
The 30-day mortality was 10% and the neurological complication rate was 10% with incomplete paraparesis in 2 patients. Computed tomography scanning revealed six endoleaks in 5 patients (Type Ia, 3 patients; Ib, 1; II, 1; III, 1) and four visceral graft occlusions in 4 patients (right renal artery, 2 patients; left renal artery, 2). Endoleaks (Ia, Ib, and III) were surgically revised. During follow-up, 3 patients died. The remaining patients recovered to full activity. A significant aneurysm shrinkage was found in 5 patients. Two patients developed secondary endoleaks.


CONCLUSIONS
Our results show that hybrid procedure might be an alternative to conventional thoracoabdominal repair of the aorta, especially in high-risk patients.
Wolf
Oliver
O
Department of Vascular Surgery, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.
Eckstein
Hans-Henning
HH
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D012077:Renal Artery / Q000601:surgery; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014781:Viscera / Q000098:blood supply*