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OBJECTIVE:
A significant portion of patients with thoracic and thoracoabdominal aortic pathologies are not candidates for open or endovascular repair due to physiological or anatomical constrains. A combination of both approaches; hybrid endovascular repair has demonstrated promising early results in experienced hands. The aim of this study is to review the utility and mid-term results of hybrid endovascular aortic using custom quadfurcated graft: the same graft design is used for the visceral/renal or brachiocephalic vessels during hybrid thoracoabdominal or transverse aortic repair.
METHODS:
Between September 2005 and November 2011, 342 patients underwent thoracic endovascular aortic repair. 195 of these patients required a combined open and endovascular approach. A total of 52 patients from this cohort required hybrid aortic repair using custom quadfurcated graft. Indications were aneurysm in 31, chronic dissection in 15, and acute dissection in 6 patients. 18 (35%) patients had extra-anatomic revascularization to the visceral and renal arteries; 34 (65%) patients underwent zone 0 hybrid arch reconstruction.
RESULTS:
Mean age was 68 ± 11 years (range 59-83 years). 15 (29%) patients had prior aortic operation or procedure. Operative procedures were urgent or emergent in 12 (23%). In 12 (23%) patients, endovascular exclusion was performed sequentially. Early mortality was 6% (n=3), two (4%) patients developed permanent stroke perioperatively. Postoperatively, no patient suffered spinal cord injury or type I or III endoleak. One patient required re-intervention. Mean follow-up was 34 ± 11 months. One-year and four-year survival rates according to Kaplan Meier was 90% and 79%. All debranching bypass grafts have remained patent.
CONCLUSIONS:
Hybrid aortic repair using custom quadfurcated graft appears to be feasible, safe and effective at mid-term follow-up, and it represents a feasible alternative in high-risk patients. Long-term surveillance requiring repeated contrast administration and radiation exposure remains an unresolved issue that requires to be addressed in future. More extensive follow-up is needed to substantiate the durability of hybrid repair using the quadfurcated aortic graft.