title: Hybrid procedures for complex thoracic aortic diseases.
abstract: BACKGROUND
  Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery.
  
  
  OBJECTIVE
  To evaluate the technique and results of hybrid procedures for CTAD.
  
  
  METHODS
  During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans.
  
  
  RESULTS
  The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. Two deaths occurred in the first 30 days after the procedure. No endoprosthesis migration was observed. No patient had paraplegia, stroke, renal failure, bleeding or coagulopathy, elective or emergency surgical conversion.
  
  
  CONCLUSIONS
  Hybrid treatment of CTAD is feasible, especially in high risk patients. Proper integration of surgical and endovascular techniques, in addition to clinical and radiological surveillance, makes this technique a great alternative to conventional surgery.
authors.affiliation: Serviço de Angiorradiologia e Cirurgia Vascular, Hospital Santa Marcelina, SP, Brazil.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Ingrund
authors.forename: Felipe
authors.initials: F
authors.lastname: Nasser
authors.forename: Seleno Glauber de
authors.initials: SG
authors.lastname: Jesus-Silva
authors.forename: Renán Prado
authors.initials: RP
authors.lastname: Limaco
authors.forename: Francisco Leonardo
authors.initials: FL
authors.lastname: Galastri
authors.forename: Marcelo Calil
authors.initials: MC
authors.lastname: Burihan
authors.forename: Carlos Edson Campos
authors.initials: CE
authors.lastname: Cunha Filho
authors.forename: Adnan
authors.initials: A
authors.lastname: Neser
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome