Clinical Outcome of Staged Versus Combined Treatment Approach of Hybrid Repair of Thoracoabdominal Aortic Aneurysm With Visceral Vessel Debranching and Aortic Endograft Exclusion

Abstract

Although visceral vessel debranching and endovascular aneurysm exclusion represents a hybrid treatment approach in patients with thoracoabdominal aortic aneurysm, the effect of timing with regard to the visceral debranching procedure and endovascular aneurysm exclusion in this treatment strategy remains unclear. In this study, the authors analyzed their recent institutional experience of visceral debranching and aneurysm stent-grafting procedures. Specifically, the authors compared the effect of staged (n = 27) versus combined (n = 31) hybrid treatment in patients with complex aortic aneurysms. This study showed a higher incidence of renal insufficiency in patients undergoing a combined hybrid repair than the staged hybrid approach. The possibility of aneurysm rupture may exist in the staged treatment approach if the duration of staged repair is prolonged. The combined hybrid treatment strategy should be performed with caution as it is associated with significantly higher complication rates than the staged hybrid treatment modality.

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

“…70,71 Retrograde revascularization of the visceral vessels (surgical bypass) followed by endovascular exclusion of the aortic aneurysmal site (open debranching technique) has been used, 72 but complication rates remain similar to that of open repair. 73,74 Other options include the chimney and snorkel techniques.…”

Cardiovascular surgeon’s role in hybrid aortic surgery (part 2)

“…Это отсутствие высокого пережатия аор-ты и торакофренотомии [3,12,21,25,32,36,37,44,57,66,69,72,85,87,92]. Первое преимущество позволяет сохра-нить стабильную гемодинамику в течение всей операции [3,44,84,92].…”

“…Третьи используют дифференцирован-ный подход: оперируют одномоментно при больших аневризмах и угрозе разрыва, стадийно при больших объ-емах реконструкции [66]. Четвертые считают, что прин-ципиальной разницы нет [57,59,85].…”

“…Сторонники одномоментной тактики отмечают, что в 19-33% случаев 2-й этап вмешательства не выполняется по причине смерти больного в межоперационном периоде или его отказа от операции [23,57]. В межоперационный период может наблюдаться быстрый рост аневризмы, рас-слоение аорты [86] и разрыв аневризмы [22,32,52,57,86,90,92], причем риск зависит от длительности межопера-ционного периода [57,67].…”

The Gore Hybrid Vascular Graft in renovisceral debranching for complex aortic aneurysm repair

“…Although several factors are supposed to be involved in such dysfunction, the most important is definitely the ischemia time during the arterial anastomosis. 10 To reduce the renovisceral ischemia during multiple bypasses, a novel tool with sutureless endovascular anastomosis 11 was developed to allow a decreasing ischemic time during sequential bypass. Subsequently, with the same rationale grew up the Gore Hybrid Vascular Graft (GHVG; W. L. Gore and Associates, Flagstaff, Ariz), which is a novel expanded polytetrafluoroethylene (ePTFE) vascular prosthesis that includes a nitinol reinforced self-expanding section at one extremity that allows a "sutureless" endovascular anastomosis.…”