Hybrid Repair of Thoracoabdominal Aortic Aneurysm with Rerouting of Visceral Arteries

  • Luca ApruzziEmail author
  • Vincenzo Ardita
  • Andrea Melloni
  • Yamume Tshomba
  • Roberto Chiesa


Despite the surgical technical evolution of open repair for thoracoabdominal aortic aneurysms (TAAA), this formidable surgical challenge is still associated with significant mortality and morbidity. In some high-risk patients, hybrid TAAA repair may allow a less-invasive approach. Usually a revascularization of visceral and renal arteries, via midline laparotomy, in a retrograde fashion from common iliac arteries is performed, and then the aneurysm is excluded with aortic endografting. This technique has the advantage of avoiding a two-cavity exposure, thoracic and suprarenal aortic cross-clamping and circulatory support, theoretically reducing visceral and spinal cord ischemia time.

Despite a less-invasive approach, the technique still represents major surgery, and the results are variable among different centers. In larger studies, the 30-day mortality rate is reported between 8.6% and 15%, and perioperative 30-day morbidity such as spinal cord ischemia, renal failure, and mesenteric ischemia is reported to be around 9%, 15%, and 8%, respectively.

A staged approach to visceral vessels debranching and aortic endograft appears to yield better results. Hybrid TAAA repair is a good option for elderly and high-risk patients who are unfit for conventional open repair and when full endovascular repair is not feasible.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luca Apruzzi
    • 1
    Email author
  • Vincenzo Ardita
    • 1
  • Andrea Melloni
    • 1
  • Yamume Tshomba
    • 2
    • 3
  • Roberto Chiesa
    • 4
  1. 1.Scientific Institute H. San Raffaele, Vita-Salute University School of MedicineMilanItaly
  2. 2.Unit of Vascular SurgeryFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
  3. 3.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly
  4. 4.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly

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