Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery

Chiesa, Roberto; Tshomba, Yamume; Melissano, Germano; Marone, Enrico Maria; Bertoglio, Luca; Setacci, Francesco; Calliari, Fabio Massimo

doi:10.1016/j.jvs.2006.10.057

Cited by 124 publications

(115 citation statements)

References 28 publications

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“…The first involves a hybrid procedure in which extra-anatomic bypasses are created to perfuse the visceral and renal vessels from the iliac arteries, followed by relining of the aorta with stent grafts. [21][22][23][24][25][26] An alternative approach, which relies solely on endovascular techniques, has been described with 2 different types of devices. The first utilizes fenestrations, or controlled holes in the fabric or the prosthesis, that are aligned and then adjoined to the respective visceral artery orifice with a balloon-expandable stent graft.…”

Section: Development Of Endovascular Aortic Repairmentioning

confidence: 99%

Endovascular Repair of Thoracoabdominal Aneurysms

2008

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Background-Morbidity and mortality after conventional repair of thoracoabdominal aneurysms remain high. Alternative techniques have been proposed and are the subject of this report. Methods and Results-Endovascular grafts that have a means of incorporating the visceral vessels into the aortic repair were divided into devices with fenestrations and those with formal branches. Hybrid procedures whereby an extra-anatomic bypass procedure is used to provide inflow to the renal and mesenteric arteries followed by aortic relining with stent grafts were reviewed and tabulated. A description of the techniques and review of the current results are provided. Only 4 series with Ͼ10 cases of hybrid procedures have been published. The experience with such a procedure suggests feasibility, but most reports describe a persistently high risk of mortality (up to 25%). Larger series of fenestrated stent grafts to treat juxtarenal aneurysms have been published, and intermediate-term results confirm the safety and efficacy of the procedure. A larger multicenter trial is under way. Other pure endovascular methods have been used to treat thoracoabdominal aneurysms with both reinforced fenestrations and directional branches. Without counting small series (Ͻ10 cases), 2 series exist with Ϸ100 cases that noted perioperative mortality rates between 3% and 6%, without evidence of late ruptures. Conclusions-Endovascular repair of thoracoabdominal aneurysms is feasible and is associated with relatively low perioperative mortality. Several methods of visceral vessel incorporation have been described. Because of persistently high mortality, hybrid procedures will likely be relegated to nonsurgical and nonendovascular patients with sizable aneurysms. Endografts with branches continue to evolve and will be assessed in the context of clinical trials.

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Section: Development Of Endovascular Aortic Repairmentioning

confidence: 99%

Endovascular Repair of Thoracoabdominal Aneurysms

2008

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“…7,8) By avoiding thoracotomy, H-TEVAR may be hypothesized to be particularly advantageous in the case of previous descending thoracic aortic repair in which a redo left-sided thoracotomy may be associated with major bleeding, increased rate of postoperative respiratory and organ failure, longer distal aortic perfusion time, longer total aortic clamping time, longer operation time, and reduced long-term survival. 2,9) It is interesting to hypothesize that existing thoracic or abdominal tube grafts in H-TEVAR may offer optimal in-graft landing zones for endografts and ideal inflow sites for visceral bypasses.…”

Section: Discussionmentioning

confidence: 99%

“…This technique is less invasive with low morbidity and mortality for high-risk patients, especially those who have undergone prior open aortic surgery. 2) In cases of aortic arch or thoracoabdominal pathologies, which often involve the origin of the supra-aortic or visceral-renal branches, it may be necessary to cover those branches using an endovascular stent graft to extend the proximal or distal landing zone. To reduce the risk of neurologic and vascular complications, adjunctive open surgical bypass surgery may be required to provide an adequate landing zone.…”

mentioning

confidence: 99%

Staged Hybrid Debranching and Thoracic Endovascular Aneurysm Repair for Multiple Aortic Aneurysms after Conventional Open Repair of the Descending Aorta: A Case Report

Matsuno

Shimabukuro

Ishida

et al. 2012

Annals of Vascular Diseases

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“…Current literature provides case reports and only a few patient series that evaluate the feasibility, as well as shortand mid-term outcomes after hybrid treatment [5][6][7][8][9][10][11]. But the number of patients treated using the hybrid approach increases.…”

Section: Introductionmentioning

confidence: 99%

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

et al. 2009

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Purpose: Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods. Methods: A hybrid approach is currently an accepted alternative to conventional surgery. Renal and/or visceral revascularisation enables subsequent stent-graft placement into the visceral portion of the aorta. Results: Knowledge of the surgical procedure and a precise assessment of the vascular morphology are crucial for pre-procedural planning and for detection of post-procedural complications. Multi-detector computed tomography angiography (MDCTA) combined with two-and threedimensional (2D and 3D) rendering is useful for pre-interventional planning and for the detection of postprocedural complications. Threedimensional rendering allows proper anatomical analyses, influencing interventional strategies and resulting in a better outcome. Conclusions: With the knowledge of procedurespecific MDCTA findings in various vascular conditions, the radiologist and surgeon are able to perform an efficient pre-interventional planning and follow-up examination. Based on our experience with this novel technique of combined open and endovascular aortic aneurysm treatment, this pictorial review illustrates procedure-specific imaging findings, including common and rare complications, with respect to 2D and 3D post-processing techniques.

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Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery

Cited by 124 publications

References 28 publications

Endovascular Repair of Thoracoabdominal Aneurysms

Endovascular Repair of Thoracoabdominal Aneurysms

Staged Hybrid Debranching and Thoracic Endovascular Aneurysm Repair for Multiple Aortic Aneurysms after Conventional Open Repair of the Descending Aorta: A Case Report

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

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