Ruptured hemiarch and descending thoracic aorta aneurysm: hybrid treatment

Abstract

Ruptured aortic arch aneurysm is a life threatening disease. Surgical repair has an high perioperative mortality rate and totally endovascular treatment is a challenge. Hybrid repair has been proposed as a valuable approach. We report the case of a patient with a contained rupture of aortic arch aneurysm. We treated him with a debranching of supraortic vessels with carotid-carotid and carotid-subclavian bypass and deployment of two enodgrafts in two different times. We consider hybrid treatment for arch and hemiarch a feasible option for aortic arch aneurysms in non emergent and in an emergency setting with an improvement in perioperative morbidity and mortality.

Hybrid Open-Endovascular Repair in a Patient With Giant Contained Aortic Aneurysm Rupture

“…When compared with open repair, HOER generally avoids prolonged aortic cross-clamping, hypothermic circulatory arrest, and pleural and double cavity invasion. 8 Hybrid openendovascular repair of ruptured aortic aneurysms is still not widely reported, 9,10 however the HOER approach has been increasingly used to repair aortic aneurysm in high-risk patients and in those without suitable anatomy for endovascular repair. [11][12][13] This selective use of HOER makes it difficult to compare its outcomes with total arch replacement.…”

Aortic coarctation and descending aortic aneurysm involving the subclavian artery: Hybrid approach to treatment

“…There are publications showing that hybrid method is effective in cases of dissections, ruptures requiring an emergency intervention, and elective cases. [8] Proximal landing zone is the distal site of left subclavian artery, therefore it is zone 2 (Z 2) or zone 3 (Z 3). It may be possible, if the aneurysm is localized in the distal site of the left subclavian artery or thoracic aortic aneurysm or in some cases of type B dissections.…”

Surgical and anesthetic considerations for the endovascular treatment of ruptured descending thoracic aortic aneurysms

“…Similarly, carotid-carotid-LSA bypass can be performed if both the LCCA and the LSA are covered [31]. Thus, coverage of the LSA or LCCA may be required to obtain adequate proximal seal.…”