Complex Thoracoabdominal Aortic Aneurysm: Hybrid Debranching with Endovascular Repair
FUMIKAZU NOMURA, MASATO SUZUKI, SHYNSUKE OHORI, KIYOTAKA MORIMOTO, KISYU FUJITA, YOHEI OHKAWA, TAKEMI OHNO.
HOKKAIDO OHNO MEMORIAL HOSPITAL, SAPPORO, Japan.
OBJECTIVE: Thoracoabdominal aortic aneurysms (TAAAs) remain a formidable surgical challenge with conventional open repair associated with significant rates of mortality and morbidity in the average center. Search for alternative approach to managing these patients has led to the development of the so-called “hybrid” method of repair including complex visceral debranching and subsequent endovascular aneurysm exclusion.
METHODS: From 2014 to 2017, 6 patients ranging from 50 to 78 yrs old with Crawford Type I: 3, Safi V: 3, dissection: 2 were operated. Open surgery was performed at the first stage. Complex visceral debranching to superior mesenteric artery and bilateral renal arteries were based off concomitantly replaced infrarenal aorta using commercially available 4-branched artificial graft (J-Graft for total arch graft replacement). Celiac artery was not revascularized and ligated. Subsequent TVAR was performed a few days after.
RESULTS: Mean operating time was 365 min, mean bleeding amount was 1243 ml. there were no operative death with one major complication of right incomplete hemiplegia.
CONCLUSIONS: The visceral hybrid repair is a feasible and relatively safe procedure for extensive thoracoabdominal aortic aneurysms. It might represent a viable alternative in a cohort of patients with high risk thoracoabdominal aneurysm. <!--EndFragment-->
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