title: Hybrid multistep approach to mega-aortic syndrome: the Lupiae technique.
abstract: OBJECTIVE
  Several techniques have been described for the treatment of thoraco-abdominal aneurysms in patients with mega-aortic syndrome (MAS), but the incidence of stroke, spinal cord injury and endoleaks remains significant. We present the mid-term results of a new hybrid, multistep technique to treat patients with MAS.
  
  
  METHODS
  From November 2005 to November 2012, 118 patients with MAS underwent surgical repair of thoracic and thoraco-abdominal aneurysms with the Lupiae technique. Fifty-five patients presented chronic aneurysms and 63 patients Type A acute dissections. Eighty-three patients underwent ascending aorta and arch replacement with a multibranched Dacron graft and epiaortic vessels rerouting (thoracic Lupiae procedure). Twenty patients had the thoracic Lupiae procedure plus partial visceral debranching (coeliac trunk and superior mesenteric artery [SMA]) through an upper mini-laparotomy. Fifteen patients had the thoracic Lupiae procedure plus a complete visceral debranching (coeliac trunk, SMA and renal arteries) using a second multibranched Dacron graft to replace the infrarenal aorta. All the patients with chronic aneurysms and 34 of 63 patients with Type A dissections underwent implant of endovascular stent grafts.
  
  
  RESULTS
  In-hospital mortality was 8.4%. No patients had stroke or spinal cord injury. The incidence of temporary renal failure was 5.2%. No patients presented endoleaks immediately and at follow-up CT scans. No death or reoperation occurred during the follow-up.
  
  
  CONCLUSIONS
  These results evidence that the Lupiae technique is a safe and effective option for the treatment of patients with MAS, achieving the complete exclusion of thoraco-abdominal aneurysms and of the residual false lumen in patients with acute aortic dissections.
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy espositogp@hotmail.com.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pennesi
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Bichi
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Patrini
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pellegrino
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Redaelli
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Poloni
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Piersilvio
authors.initials: P
authors.lastname: Gerometta
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Gentinetta
authors.affiliation: Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Giangiuseppe
authors.initials: G
authors.lastname: Cappabianca
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D012189:Retrospective Studies; D015607:Stents
chemical_list: D011093:Polyethylene Terephthalates
keywords: Aortic debranching; Hybrid repair; Thoraco-abdominal aneurysms