Combined Open and Endovascular Treatment of Complex Aortic Disease

Abstract

The purpose of this article is to report whether combined open and endovascular treatment could be applied in patients with complex aortic disease. A retrospective study including four patients with complex aortic disease was undertaken. In all patients, extra-anatomic bypass to the visceral arteries was made through a laparotomy while the aortic lesion was repaired by stent grafting. One patient died on the first postoperative day and another died 3 months after treatment from a myocardial infarction. The other two patients were alive 13 and 34 months after treatment, respectively. However, a patient treated for a ruptured thoracoabdominal type 2 aneurysm on the basis of a dissection suffers from postoperative paraplegia. The combination of open surgery with extra-anatomic bypass to visceral arteries and stent grafting could be an option for the treatment of patients with complex aortic disease, especially in high-risk cases in which more extensive open surgery is contraindicated.

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

“…Several other smaller case series of TAAA hybrid repair similarly reported high operative mortality rates, which ranged from 25% to 33%. 16,19,20 The findings from our series as well as those reported by others beg the question: "Is the hybrid treatment strategy a truly less-invasive treatment of TAAA?" Considering the technical steps involved in a hybrid approach, there are clearly limitations that may preclude its wide adaptation in all patients with TAAA.…”

“…Several other smaller case series of TAAA hybrid repair similarly reported high operative mortality rates, which ranged from 25% to 33%. 16,19,20…”

“…23,28 Despite this seemingly logical theoretical benefit, many published studies regarding this treatment strategy continue to report a high incidence of perioperative morbidity and mortality, 15,16,[18][19][20][21]28,29 whereas others advocated the safety and efficacy of this hybrid treatment approach. 17,[22][23][24]27 The disparity of the widely reported treatment outcome may be due in part to the difference in patient selection, surgical technique, as well as the staged treatment strategy between the debranching operation and endovascular procedure.…”

“…23,24 The theoretical benefits are yet to be validated in the literature as reported series from the literature regarding this hybrid approach have noted a wide range of operative mortality from 0% to 38%. 15-21 The mixed results from various clinical series underscore the therapeutic complexity as well as the wide disparity in the hybrid treatment approach of this challenging condition. In this report, we examine the outcome of the hybrid approach of TAAA with a particular focus on the timing factor between the visceral bypass and endograft implantation.…”

Traumatic Superior Mesenteric Arteriovenous Fistula and Aortic Pseudoaneurysm 20 Years after Repair

“…''Neck lengthening'' techniques combining extra-anatomic bypasses (ie, hepatorenal, iliorenal, aortorenal, aortosuperior mesenteric, or aortoceliac) to revascularize covered visceral vessels have been described and successfully performed. 14,15 Aortoenteric fistula is a late-occurring, rare (0.7%) complication after aortic surgery, but the perioperative mortality is extremely high (50-75%). 16 Extra-anatomic bypass with resection of the infected graft is the gold standard operation and historically has yielded the best long-term results.…”