Hybrid Approach of Aortic Diseases: Zone 1 Delivery and Volumetric Analysis on the Descending Aorta

Abstract

IntroductionConventional techniques of surgical correction of arch and descending aortic diseases remains as high-risk procedures. Endovascular treatments of abdominal and descending thoracic aorta have lower surgical risk. Evolution of both techniques - open debranching of the arch and endovascular approach of the descending aorta - may extend a less invasive endovascular treatment for a more extensive disease with necessity of proximal landing zone in the arch.ObjectiveTo evaluate descending thoracic aortic remodeling by means of volumetric analysis after hybrid approach of aortic arch debranching and stenting the descending aorta.MethodsRetrospective review of seven consecutive patients treated between September 2014 and August 2016 for diseases of proximal descending aorta (aneurysms and dissections) by hybrid approach to deliver the endograft at zone 1. Computed tomography angiography were analyzed using a specific software to calculate descending thoracic aorta volumes pre- and postoperatively.ResultsFollow-up was done in 100% of patients with a median time of 321 days (range, 41-625 days). No deaths or permanent neurological complications were observed. There were no endoleaks or stent migrations. Freedom from reintervention was 100% at 300 days and 66% at 600 days. Median volume reduction was of 45.5 cm3, representing a median volume shrinkage by 9.3%.ConclusionHybrid approach of arch and descending thoracic aorta diseases is feasible and leads to a favorable aortic remodeling with significant volume reduction.

Desvendando as Controvérsias da Dissecção Aórtica Tipo B – Interpretando as Evidências

“…Permanece um debate continuado sobre a melhor estratégia de tratamento para a DATB. 11 As opções incluem o tratamento clínico com controle da pressão arterial e monitoramento regular, o reparo endovascular (TEVAR) ou a cirurgia aberta. Determinar a abordagem mais adequada depende de diversos fatores, como o grau da disseção, a presença de complicações e o estado geral do paciente.…”

“…7,10 There is an ongoing debate over the best treatment strategy for TBAD. 11 Options include medical management with blood pressure control and close monitoring, endovascular repair (TEVAR), or open surgical repair. Determining the most appropriate approach depends on various factors, such as the dissection extension, the presence of complications, and the patient's general health.…”