title: Hybrid repair of aortic arch pathology.
abstract: The objective was to evaluate a 13-year single-centre experience of arch endovascular aortic repair using the hybrid approach. Between 1999 and 2013, 491 patients were treated with endografts for thoracic aortic pathologies. The aortic arch was involved in 179 (36.5%) patients (128 men; mean age 70.2 ± 10.8 years, range 27-84). A hybrid approach was performed for all Zone 0 and 1 procedures and in nearly half of Zone 2 procedures. Early and mid-term outcomes were reviewed retrospectively. Overall primary technical success (24 h) was achieved in 162 (90.5%) of the 179 cases; 2 deaths and 15 Type 1 endoleaks were observed. Clinical success at 30 days was achieved in 161 (89.9%) of the 179 patients, with a mortality rate of 4.5% (8/179). Short-term clinical success at 6 months was achieved in 169 (94.4%) of the 179 patients; the rates for the different landing zones did not differ significantly. At a mean follow-up of 27.3 ± 15.7 months (range 1-94), the mid-term clinical success was 165 (92.2%) of the 179 patients; the rates among the different proximal zones did not differ significantly. In selected patients, early and mid-term outcomes of arch endovascular aortic repair using the hybrid approach are promising; however, mortality and morbidity are not negligible. Our results may have practical implications for the ongoing evaluation of the hybrid procedure in the aortic arch, as well as for patients fit for traditional surgery.
authors.affiliation: 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy r.chiesa@hsr.it chiesa.roberto@hsr.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
authors.affiliation: 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bertoglio
authors.affiliation: 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Rinaldi
authors.affiliation: 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy.
authors.forename: Yamume
authors.initials: Y
authors.lastname: Tshomba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D001018:Aortic Diseases / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aneurysm; Arch; Debranching; Endovascular; Hybrid; Stent-graft