Hybrid Open-endovascular Repair for Thoracoabdominal Aortic Aneurysms: Current Status and Level of Evidence

Abstract

HOER shows promising mid-term results for high-risk patients who have TAAA, however, present evidence does not allow robust conclusions.

Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms:

“…1 The use of the hybrid approach avoids important factors that contribute to spinal cord ischemia, such as aortic cross clamping, intraoperative hemodynamic instability, and reperfusion injuries, which likely plays a significant role in reducing postoperative neurological deficits. 36 Considering that the occurrence of renal impairment after a hybrid procedure is also comparable to that of open repair in centers of excellence, patients seem to benefit from the total avoidance of aortic cross-clamping and the reduced ischemia time during revascularization of the renal arteries. 16…”

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

“…The thoracic aorta has also been reported as an inflow site for hybrid procedures, 31 but this approach can be adopted only in type IV TAAAs and anastomotic and pararenal aneurysms. Current results of hybrid surgery for type IV TAAA are disappointing, with surgical mortality >15% due to retrograde revascularization from the iliac arteries.…”

Staged Visceral Bypass With Aortic Relining for Thoracoabdominal Aneurysms: Future Perspectives

“…2,8,9,17,20,25 Specific complications that have resulted from the adoption of this technique are prolonged ileus and pancreatitis. 2,24,28 The issue of prolonged ileus is poorly understood and may result from a number of factors. Specifically, dissection of the origins of the visceral vessels may result in temporary disruption to the sympathetic visceral supply leading to an ileus.…”

“…The early concerns around visceral vessel patency have proved to be unfounded and patency rates are in the region of 97%. 24,28 The grafts most likely to be at risk are the renal vessels with patency rates of 93% as compared with one reported episode of loss of the celiac vessels. Clearly, an occlusion of the superior mesenteric artery would be catastrophic.…”