title: Clinical outcomes of hybrid repair for thoracoabdominal aortic aneurysms.
abstract: BACKGROUND
  Thoracoabdominal aortic aneurysm (TAAA) hybrid repair consists of aortic visceral branch rerouting followed by TAAA endograft exclusion. This technique has been shown to represent a technically feasible strategy in selected patients.
  
  
  METHODS
  We analyzed 52 high-risk patients who underwent hybrid TAAA repair between 2001 and 2012 in our centre with a variety of visceral rerouting configurations and of commercially available thoracic endografts. Thirty-seven simultaneous (71.2%) and 15 staged procedures (21.8%) were performed with a four-vessel revascularization in 18 cases (34.6%), a three-vessel revascularization in 11 cases (21.2%) and a two-vessel revascularization in 23 cases (44.2%).
  
  
  RESULTS
  No intraoperative deaths were observed. We recorded a perioperative mortality rate of 13.5% (n=7), including deaths from multiorgan failure (n=2), myocardial infarction (n=2), coagulopathy (n=1), pancreatitis (n=1) and bowel infarction (n=1). Perioperative morbidity rate was 28.8% (n=15), including 2 cases of transient paraparesis and 1 case of permanent paraplegia. Renal failure (n=5), pancreatitis (n=3), respiratory failure (n=3) and dysphagia (n=1) were also observed. At median follow-up of 23.9 months procedure-related mortality rate was 9.6%: two patients died from visceral graft occlusion and three from aortic rupture. There were three endoleaks and one endograft migration, none of which resulted in death. Five patients (9.6%) died as a consequence of unrelated events.
  
  
  CONCLUSIONS
  Typical complications of conventional TAAA open surgery have not been eliminated by hybrid repair, and significant mortality and morbidity rates have been recorded. Fate of visceral bypasses and incidence of endoleak and other endograft-related complications needs to be carefully assessed. Hybrid TAAA repair should currently be limited to high-risk surgical patients with unfit anatomy for endovascular repair.
authors: Department of Vascular Surgery, University Vita-Salute, IRCCS O. San Raffaele, Milan, Italy.
authors: Yamume
authors: Y
authors: Tshomba
authors: Germano
authors: G
authors: Melissano
authors: Davide
authors: D
authors: Logaldo
authors: Enrico
authors: E
authors: Rinaldi
authors: Luca
authors: L
authors: Bertoglio
authors: Efrem
authors: E
authors: Civilini
authors: Daniele
authors: D
authors: Psacharopulo
authors: Roberto
authors: R
authors: Chiesa
keywords: Thoracoabdominal; aneurysm; aorta; endovascular; hybrid
references: J Vasc Surg. 2008 Jan;47(1):6-16
references: 17980540
references: J Vasc Surg. 2012 Mar;55(3):659-65
references: 22169669
references: Circulation. 2008 Apr 29;117(17):2288-96
references: 18443250
references: Semin Thorac Cardiovasc Surg. 2003 Oct;15(4):326-32
references: 14710373
references: J Endovasc Ther. 2006 Aug;13(4):481-9
references: 16928162
references: Tex Heart Inst J. 2011;38(6):687-90
references: 22199437
references: Ann Surg. 2002 Oct;236(4):471-9; discussion 479
references: 12368676
references: J Vasc Surg. 2006 Oct;44(4):688-93
references: 16926086
references: Ann Vasc Surg. 2006 Mar;20(2):188-94
references: 16550478
references: J Am Coll Surg. 2007 Sep;205(3):420-31
references: 17765158
references: J Vasc Surg. 2012 Jul;56(1):65-73
references: 22560310
references: Ann Surg. 2010 Nov;252(5):884-9
references: 21037446
references: Ann Thorac Surg. 2007 Feb;83(2):S862-4; discussion S890-2
references: 17257942
references: Eur J Vasc Endovasc Surg. 2005 Apr;29(4):383-9
references: 15749039
references: J Vasc Surg. 2001 Sep;34(3):405-9; discussion 410
references: 11533590
references: J Vasc Surg. 2004 Jun;39(6):1163-70
references: 15192553
references: J Vasc Surg. 2002 Apr;35(4):631-9
references: 11932655
references: J Card Surg. 2003 Jul-Aug;18(4):359-66
references: 12869184
references: Ann Thorac Surg. 2002 Nov;74(5):S1881-4; discussion S1892-8
references: 12440686
references: J Cardiovasc Surg (Torino). 2010 Dec;51(6):821-32
references: 21124278
references: J Vasc Surg. 1999 Jan;29(1):150-6
references: 9882799
references: J Endovasc Ther. 2011 Oct;18(5):642-9
references: 21992633
references: Eur J Vasc Endovasc Surg. 2007 Oct;34(4):461-9
references: 17683959
references: J Vasc Surg. 2000 Jan;31(1 Pt 1):147-56
references: 10642717
references: J Endovasc Ther. 2009 Apr;16(2):238-42
references: 19456196
references: Ann Thorac Surg. 1999 Jun;67(6):1931-4; discussion 1953-8
references: 10391341
references: Acta Chir Belg. 2008 Sep-Oct;108(5):492-502
references: 19051455
references: J Vasc Surg. 2005 Jul;42(1):11-7
references: 16012446
references: J Vasc Surg. 2007 Jun;45(6):1128-35
references: 17543675
references: J Vasc Surg. 2008 Apr;47(4):724-32
references: 18381133
references: Eur J Vasc Endovasc Surg. 2009 Jul;38(1):26-34
references: 19523598
references: Ann Surg. 1978 Sep;188(3):404-22
references: 686902
references: Ann Thorac Surg. 2004 Apr;77(4):1304-8
references: 15063256
references: Eur J Cardiothorac Surg. 2001 Sep;20(3):520-6
references: 11509273
references: J Vasc Surg. 2006 Jun;43(6):1081-9; discussion 1089
references: 16765218
references: Masui. 2004 Nov;53(11):1253-8
references: 15587175
references: J Endovasc Ther. 2004 Jun;11(3):330-3
references: 15174918
references: Eur J Cardiothorac Surg. 2004 May;25(5):701-7
references: 15082270
references: J Vasc Surg. 2012 Apr;55(4):1202-5
references: 22305272
references: J Vasc Surg. 2008 Nov;48(5):1083-91
references: 18692351
references: Circulation. 2008 Aug 19;118(8):808-17
references: 18678769