title: Clinical outcomes in hybrid repair procedures for pathologies involving the aortic arch.
abstract: OBJECTIVE
  Fifty patients with complex aortic disease, who received hybrid treatment of the aortic arch with supra-aortic debranching and endovascular stent-graft repair, were evaluated in regard to events of primary (survival and technical success) and secondary (procedure-related complications) interest.
  
  
  METHODS
  The single-center study was conducted over an eight-year period from December 2004 to December 2012. Treated medical conditions included 23 aortic aneurysms (46%), 21 aortic dissections (42%), and six penetrating aortic ulcers (12%). Procedures were divided into groups of elective, urgent, and emergent.
  
  
  RESULTS
  Twenty-eight (56%) patients were operated electively, 15 (30%) urgently, and seven (14%) emergently. Sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest were required in 12 (24%) patients. The primary technical success rate was 86% and raised to 92% (n=46) of secondary technical success rate after therapy of three type I endoleaks. The 30-day mortality added up to 16.0%, and the mean time of survival was 49.3 months. In a total of eight (16%) patients, an endoleak occurred (five endoleaks type I, three endoleaks type II), while nine (18%) of patients suffered a perioperative stroke.
  
  
  CONCLUSIONS
  In severely ill patients with complex aortic diseases, hybrid therapy may offer a promising alternative to conventional open repair.
authors.affiliation: Department of Vascular surgery, Klinikum Augsburg, Germany sebastian.zerwes@klinikum-augsburg.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Zerwes
authors.affiliation: Department of Radiology, Klinikum Augsburg, Germany.
authors.forename: Giesbert
authors.initials: G
authors.lastname: Leissner
authors.affiliation: Department of Vascular surgery, Klinikum Augsburg, Germany.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Gosslau
authors.affiliation: Department of Vascular surgery, Klinikum Augsburg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jakob
authors.affiliation: Department of Vascular surgery, Klinikum Augsburg, Germany.
authors.forename: Hans-Kees
authors.initials: HK
authors.lastname: Bruijnen
authors.affiliation: Department of Cardiac surgery, Klinikum Augsburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Oertl
authors.affiliation: Department of Vascular surgery, Klinikum Augsburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Woelfle
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D017558:Elective Surgical Procedures; D004630:Emergencies; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D056346:Sternotomy; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Hybrid repair; aortic arch; aortic dissection; clinical results; debranching; stroke