Comparative Outcomes of Open, Hybrid, and Fenestrated Branched Endovascular Repair of Extent II and III Thoracoabdominal Aortic Aneurysms

Arnaoutakis, Dean J.; Scali, Salvatore T.; Beck, Adam W.; Huber, Thomas S.; Martin, Andrew; Laquian, Liza; Beaver, Thomas M.; Upchurch, Gilbert R.

doi:10.1016/j.jvs.2018.10.012

Cited by 10 publications

(12 citation statements)

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“…In another study that included 52 patients, the perioperative mortality rate for hybrid surgery was 8.6-13.5% (7). In a study comparing hybrid surgery with a completely open or endovascular approach, the overall 30-day case-fatality rate was 13% and the overall complication incidence was 33% in 40 patients who received hybrid surgery (8). In another study that included 10 patients undergoing hybrid surgery, three patients (30%) required postoperative dialysis, but none of them required it permanently; one patient (10%) experienced paraplegia (which was transient in other patients and improved by cerebrospinal fluid drainage) (9).…”

Section: Discussionmentioning

confidence: 99%

Short-term effectiveness and safety of an anatomy-conforming hybrid surgery protocol for thoracoabdominal aortic aneurysms

Zhang

et al. 2021

Ann Palliat Med

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Background: Thoracoabdominal aortic aneurysms (TAAAs) are one of the most complex aortic aneurysms to treat. Traditional open surgery for TAAAs is highly invasive and total endovascular treatment still has many limitations. Hybrid surgery offers a viable option for TAAA patients, but currently it often alters the original hemodynamics. Therefore, we have developed and applied a hybrid surgery protocol for anatomically suitable TAAA patients. Here we analyzed the short-term outcomes of these patients and evaluated the effectiveness and safety of this procedure. Methods: A new method was used to perform the required artificial revascularization of the abdominal aorta and its branches. A new visceral debranching and reconstruction approach was used to complete an anatomy-conforming open surgery. Finally, a new vascular access was used for the endovascular operation to complete the implantation of stent-grafts. The clinical data of 10 patients with TAAAs treated at our center with the anatomy-conforming hybrid technique during the period from May 2018 to June 2020 was retrospectively analyzed. The intraoperative and 30-day postoperative key indicators, including survival rates and complications, were analyzed.Results: The hybrid surgery was smoothly performed in all 10 patients. One patient died from non-aortic causes (sepsis/infectious toxic shock) 30 days after surgery, yielding a case-fatality rate of 10.0% (1/10).Two patients (2/10) experienced serious complications within 30 days postoperatively, including multiorgan failure due to infection in one patient and lower limb ischemia in another patient who went on to develop permanent paraplegia. No endoleak after stent implantation was noted and the blood supply of each reconstructed visceral artery was good.Conclusions: Based on the short-term outcomes, the anatomy-conforming hybrid surgical protocol is safe and effective in treating TAAA patients.

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Section: Discussionmentioning

confidence: 99%

Short-term effectiveness and safety of an anatomy-conforming hybrid surgery protocol for thoracoabdominal aortic aneurysms

Zhang

et al. 2021

Ann Palliat Med

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“…Although lower than total endovascular repair, the rate associated with hybrid repairs ranges Includes a cohort treated with physician-modified stent-grafts. from 1.2% to 13% in the literature, 6,[19][20][21][22][23][24][25][26] indicating that there is still a long way to go to diminish this pathology. In the report by Yang et al, 1 the 10% rate corresponds to the literature.…”

Section: Hybrid Taaa Repairmentioning

confidence: 99%

“…Concerning acute renal failure, the rate of deterioration was low; however, the authors had to deal with a high rate of new-onset dialysis at 30 days. Table 2 lists reports 6,[19][20][21][22][23][24][25][26] after the last meta-analysis by Canaud et al 17 in 2013.…”

Section: Hybrid Taaa Repairmentioning

confidence: 99%

Commentary: Physician-Modified Fenestrated/Branched EVAR and Hybrid Techniques for Acute Thoracoabdominal Aortic Pathologies: Inequality When Comparing Alternative Options With Different Philosophies Does Not Equal Lower Quality

2020

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“…The downside is that it still requires laparotomy and long operative time. Although the hybrid repair was developed as a lessinvasive approach than the traditional open TAAA repair, the 30-day mortality after hybrid techniques in many series are disappointingly high, ranging from 10% to 26%, [6][7][8][9][10][11][12][13] which may be due to the technique being applied to patients unfit or high-risk for traditional open TAAA repair. Controversial excellent outcomes were reported by Patel and colleagues in 2010, 14 with only 1 death in the series of 29 hybrid repairs, and Yang and colleagues in 2020, 15 with 1 death in the series of 28 hybrid repairs.…”

Section: Hybrid Taaa Repairmentioning

confidence: 99%

Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels

2021

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Open thoracoabdominal aortic aneurysm (TAAA) repair remains a surgical challenge. Hybrid and total endovascular repair have emerged as alternatives in treating TAAA. Total endovascular TAAA repair may be best performed with branched/ fenestrated stent grafts. However, these technologies are not yet widely available. Thus, currently total endovascular TAAA repair using the chimney/snorkel techniques is considered a viable option in many centers.In this article, we briefly review 2 readily available techniques with off-the-shelf devices, hybrid procedure using total abdominal debranching, and total endovascular repair using chimney/snorkel procedures. The hybrid TAAA repair avoids thoracotomy but requires laparotomy and carries high morbidity and mortality (eg, operative mortality, 4%-26% and renal failure, 4%-26%), comparable to traditional open repair. The staged hybrid approach has been proposed to minimize the invasiveness of the procedure, whereas the associated risk of interval aortic deaths is not negligible. Total endovascular repair reduces the morbidity and mortality after TAAA repair (eg, operative mortality, 3%-20% and renal failure, 0%-20%). However, it is technically demanding and the risks of future reinterventions-and need for repetitive surveillance-is inevitable (eg, immediate type I endoleak, 7%-16% and 1-year branch patency, 93%-98%). Currently, there are not enough data to determine which less-invasive option for open repair in patients with TAAA is superior. These alternatives should complement each other and be applied to carefully selected populations as a part of the overall toolbox in treating TAAA. (JTCVS Techniques 2021-:1-6) Illustration of the sandwich technique. CENTRAL MESSAGEMore data are required to determine the best option for open TAAA repair. Options should complement one another and be applied to selected populations as a part of the overall toolbox to treat TAAA. See Commentary on page XXX.Video clip is available online. BACKGROUNDOpen thoracoabdominal aortic aneurysm (TAAA) repair remains among the most difficult surgical challenges due to the associated vital structures, such as visceral/renal branches and segmental arteries involved in the lesion. Recent reports from large-volume aortic centers demonstrate operative mortality after open TAAA repairs in young patients (younger than age 50 years) is 3% to 6%. 1,2 However, despite the evolution in surgical techniques and perioperative care, mortality in older patients remains 8% to 17%, even in experienced hands. 1,2 Hybrid procedures, which combine open and endovascular techniques, to treat TAAA has been proposed 3 to minimize the surgical insults and improve outcomes, especially in high-risk patients. Another alternative approach to traditional open repair is total endovascular repair with visceral parallel graft (chimney/snorkel) techniques using off-the-shelf devices. Further, physicianmodified, multibranched stent graft was introduced in 2001, 4 and now off-the-shelf and custom-made branched/fenestrated stent grafts to t...

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Comparative Outcomes of Open, Hybrid, and Fenestrated Branched Endovascular Repair of Extent II and III Thoracoabdominal Aortic Aneurysms

Cited by 10 publications

References 0 publications

Short-term effectiveness and safety of an anatomy-conforming hybrid surgery protocol for thoracoabdominal aortic aneurysms

Short-term effectiveness and safety of an anatomy-conforming hybrid surgery protocol for thoracoabdominal aortic aneurysms

Commentary: Physician-Modified Fenestrated/Branched EVAR and Hybrid Techniques for Acute Thoracoabdominal Aortic Pathologies: Inequality When Comparing Alternative Options With Different Philosophies Does Not Equal Lower Quality

Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels

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