Hybrid Aortic Arch Repairs

Abstract

Hybrid aortic arch repair (HAAR) consists of thoracic stent-graft repair and procedures to maintain cerebral blood flow. Several hybrid techniques have been used, including arch artery debranching, parallel graft technique, fenestration or branching of endograft, or a combination of these. We provided an overview of HAAR by presenting literature reviews as well as our clinical experience. The experience consisted of 172 patients who had undergone HAAR. The 30-day mortality was 3% (5/172). Persistent neurologic deficits occurred in 7 patients (4%), respiratory failure in 5 (3%), de novo aortic dissection in 3 and spinal cord injury in 2. 17% of the patients experienced type Ia endoleak. Seventeen patients required redo thoracic endovascular aortic repair. Fifty-six late deaths occurred during the follow-up period, including aortic-related death in 9 patients. In conclusion, hybrid arch debranching repair should be performed for elderly or high-surgical-risk patients. However, refining techniques and device technology is likely to reduce late endograft-related events. (This is a translation of Jpn J Vasc Surg 2018; 27: 385–391.)

Anatomic Utility of Single Branched Thoracic Endograft During Thoracic Endovascular Aortic Repair

“…6,8,14 The benefits of TEVAR have led to an expansion of its application to include landing the graft into the aortic arch. [15][16][17][18] Achieving a proximal seal in the aortic arch requires coverage of one or more of the supra-aortic branch vessels. There are a variety of methods which have been utilized to revascularize these covered aortic branches including mediastinal debranching, extra-anatomic bypass, parallel stent grafts, graft fenestration, and the use of branched endovascular stent grafts.…”

“…There are a variety of methods which have been utilized to revascularize these covered aortic branches including mediastinal debranching, extra-anatomic bypass, parallel stent grafts, graft fenestration, and the use of branched endovascular stent grafts. [15][16][17][18]20,21,[25][26][27][28][29][30][31] The need to achieve seal at or proximal to zone 2 is common and necessary in upwards of 40% of patients treated for descending thoracic aneurysms. 20 In our series, proximal seal was achieved at or proximal to zone 2 in 60% of the patients; 40% in zone 2 and 20% in zone 0 or zone 1.…”

“…This practice is often used to avoid the morbidity of an open repair. [15][16][17][18][19] Single branched thoracic endografts have been designed and evaluated to achieve proximal seal in Ishimura zone 2 18 while maintaining LSA patency through the use of a branched stent graft. 20,21 Although the necessity of revascularization during intentional coverage of the LSA remains controversial, The Society of Vascular Surgery practice guideline recommend routine LSA revascularization for elective TEVAR procedures.…”

Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching

“…Cost is another issue. Intraoperative fenestration is another technique, however, these methods require experience and learning time to be performed as a practical and successful method [ 10 ] . Snorkel and Chimney techniques may also be applied, but they were found to be associated with higher Type 1 endoleaks and complication rates than fenestrated EVAR.…”