Introductions
Conventional open thoracoabdominal aortic aneurysm repairs are associated with high mortality rates and if they left untreated they may be lethal. Many factors such as cardiopulmonary bypass requirement, aortic cross-clamping and technique difficulties in obese patients may limit operation success. Endovascular aneurysm repair (EVAR) has become a viable option to treat these pathologies with promising results. However, endovascular approaches could not become feasible solution in most of the complex aortic aneurysms involving visceral vessels yet. Therefore, a hybrid approach with visceral debranching could be a favorable alternative for patients with these complex conditions.
Method
Between 2012 and 2015, 5 patients (the mean age of 67 ± 8 years-old) underwent type IV or V hybrid thoracoabdominal aortic aneurysm repair with different debranching approaches. The extent of debranching and the strategy of surgical approach were determined on individual patient pathophysiology requiring coverage of either landing zone or visceral bypass requirement. The hybrid arch concept essentially entails three main principles: (I) open debranching of the great vessels; (II) creation of proper proximal and distal landing zones, and; (III) concomitant or delayed bypass grafting of the visceral arteries. All patients were followed prospectively based on mortality, stroke, hospital stay, aneurysm diameter, patency of the bypass grafts and endostent-related morbidity. Descriptive statistics, including means and standard deviations for continuous measures and frequencies for categorical measures, were generated using SPSS 21.0 (Statistical Package for the Social Sciences, SPSS Inc.).
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