Hybrid Repair With Antegrade Visceral Artery Debranching: The Preferred Treatment Option for Thoracoabdominal Aneurysms in High-Risk Patients

Abstract

Purpose

To present a hybrid repair technique that may decrease the morbidity and mortality associated with thoracoabdominal aneurysm (TAAA) repair, especially in high-risk patients.

Methods

A retrospective analysis was performed of patients treated for TAAA at a single institution from 2005 to 2010. Nine patients (8 men; mean age 72 years) with Crawford types II or IV TAAAs were treated with a 2-stage hybrid technique consisting of antegrade visceral debranching of the aorta, followed within a month by endovascular deployment of endografts to cover the entire diseased aortic segment.

Results

There was no perioperative mortality, paraplegia, or permanent renal failure. Following the debranching procedure, there were 4 cases of transient renal dysfunction, 1 minor stroke (resolved), and 1 low-flow pancreatic fistula that regressed. There were no complications after the endovascular repair. Over a mean follow-up of 28 months (range 8–50), all patients are alive, with good patency of the bypass grafts and endografts. One late type II endoleak is under surveillance.

Conclusion

This small series shows that the ascending aorta is a safe location for antegrade visceral debranching, which could facilitate hybrid repair in most cases, especially those patients with advanced lesions of the iliac arteries. More patients and longer follow-up are required to draw definite conclusions for the adoption of this treatment in high-risk patients.