Abstract
Purpose
To minimize surgical invasiveness for extensive aortic aneurysms and expand the indications for thoracic endovascular aortic repair (TEVAR), we evaluated outcomes of hybrid procedures combining conventional surgical aortic repair and TEVAR for thoracic aortic aneurysms.
Methods
The following hybrid procedures were performed: second-stage TEVAR after total aortic arch replacement using the elephant trunk as the landing zone in 17 patients; and for multiple aortic aneurysms, vascular graft replacement and TEVAR in 13 patients, vascular graft replacement and TEVAR with bypass in 2 patients, and TEVAR with bypass in 23 patients.
Results
There were three (5.3%) hospital deaths, from serious complications including stroke, paraplegia, paraparesis, and aspiration pneumonia; and eight late deaths. There was only one aneurysm-related death, of a patient who underwent emergency surgery for an esophageal fistula resulting from enlargement of a residual false lumen of a thoracoabdominal aorta after second-stage TEVAR.
Conclusion
Hybrid procedures minimize surgical invasiveness in thoracic aortic aneurysm repair, but further evaluation of a larger number of patients is necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kawaguchi S, Yokoi Y, Shimazaki T, Koide K, Matsumoto M, Shigematsu S. Thoracic endovascular aneurysm repair in Japan: experience with fenestrated stent grafts in the treatment of distal arch aneurysms. J Vasc Surg 2008;48(6 suppl):24–29S.
Lovegrove RE, Javid M, Magee TR, Galland RB. A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 2008;95:677–684.
Sasan N, Thomas TT, Victor JW, MacDonald MJ, Peter HL, Douglas CR, et al. Endoluminal versus open treatment of descending thoracic aortic aneurysms. J Vasc Surg 2002;36:732–737.
Verhoeven EL, Zeebregts CJ, Kapma MR, Tielliu IF, Prins TR, van den Dungen JJ. Fenestrated and branched endovascular techniques for thoracoabdominal aneurysm repair. J Cardiovasc Surg 2005;46:131–140.
Yano H, Ishimaru S, Kawaguchi S, Obitsu Y. Endovascular stent grafting of the descending thoracic aorta after arch repair in acute type A dissection. Ann Thorac Surg 2002;73:288–291.
Greenberg RK, Haddad F, Svensson L, O’Neill S, Walker E, Lyden SP, et al. Hybrid approach to thoracic aortic aneurysms: The role of endovascular elephant trunk completion. Circulation 2005;112:2619–2626.
Obitsu Y, Koizumi N, Iida Y, Satou K, Watanabe Y, Takae H, et al. Hybrid treatment of multiple aortic aneurysms by combined surgery and endovascular aortic repair. Ann Vasc Dis 2008;1:40–44.
Watanabe Y, Ishimaru S, Kawaguchi S, Shimazaki T, Yokoi Y, Ito M, et al. Successful endografting with simultaneous visceral artery bypass grafting for severely calcified thoracoabdominal aortic aneurysm. J Vasc Surg 2002;35:397–399.
Saiki N, Ishimaru S, Kawaguchi S, Shimazaki T, Yokoi Y, Obitsu Y. Endografting facilitated by axillary-axillary bypass for distal arch aneurysm after left internal thoracic artery to left anterior descending artery bypass surgery. J Cardiovasc Surg 2003;125:950–952.
Black SA, Wolfe JH, Clark M, Hamady M, Cheshire NJ, Jenkins MP. Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg 2006;43:1081–1089.
Szeto WY, Bavaria JE, Bowen FW, Woo EY, Fairman RM, Pochettino A. The hybrid total arch repair: Brachiocephlic bypass and concomitant endovascular aortic arch stent graft placement. J Card Surg 2007;22:97–102.
Kouchoukos NT, Mauney MC, Masetti P, Castner CF. Single-stage repair of extensive thoracic aortic aneurysms: Experience with the arch-first technique and bilateral anterior thoracotomy. J Thorac Cardiovasc Surg 2004;128:669–676.
Ueda Y, Fujii Y, Udagawa H. Thoracic and cardiovascular surgery in Japan during 2006. Gen Thorac Cardiovasc Surg 2008;56:365–388.
Safi HJ, Miller CC 3rd, Estrera AL, Huynh TT, Rubenstein FS, Subramaniam MH, et al. Staged repair of extensive aortic aneurysms: morbidity and mortality in the elephant trunk technique. Circulation 2001;104:2938–2942.
Buth J, Harris PL, Hobo R, Eps R, Cuypers P, Duijm L, et al. European collaborators on Stent / Graft techniques for aneurysm repair (EUROSTAR) registry. J Vasc Surg 2007;1103–1109.
Yang J, Zuo J, Yang L, Duan W, Xiong L, Zheng M, et al. Endovascular stent-graft treatment of thoracic aortic dissection. Interact Cardiovasc Thoracic Surg 2006;5:688–691.
Suzuki S, Matsuda M. An update on surgery for type A aortic dissection: aortic root repair, endovascular stent graft and genetic research. Surg Today 2009;39:281–289.
Shimono T, Kato N, Yasuda F, Suzuki T, Yuasa U, Onoda K, et al. Transluminal stent-graft placement for the treatment of acute onset and chronic aortic dissections. Circulation 2002;106:1241–1247.
Rubin S, Bayle A, Poncet A, Baehrel B. Retrograde aortic dissection after a stent graft repair of a type B dissections; how to improve the endovascular technique. Interact Cardiovasc Thoracic Surg 2006;5:746–748.
Resch TA, Delle M, Falkenberg M, Ivancev K, Konrad P, Larzon T, et al. Remodeling of the thoracic aorta after stent grafting of type B dissection: a Swedish multicenter study. J Cardiovasc Surg (Torino) 2006;47:503–508.
Schoder M, Czerny M, Cejna M, Rand T, Stadler A, Sodeck GH, et al. Endovascular repair of acute type B aortic dissection: longterm follow-up of true and false lumen diameter changes. Ann Thorac Surg 2007;83:1059–166.
Bockler D, Kotelis D, Geisbusch P, Geisbusch P, Hyhilik-Durr A, Klemm K, et al. Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections- a single center experience in 28 patients. J Vasc Surg 2008;47:724–732.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Obitsu, Y., Koizumi, N., Takahashi, S. et al. Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms. Surg Today 41, 922–927 (2011). https://doi.org/10.1007/s00595-010-4377-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-010-4377-y