Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: Surgical challenges and clinical outcomes

Wei, Zhou; Reardon, Michael J.; Peden, Eric K.; Lin, Peter H.; Lumsden, Alan B.

doi:10.1016/j.jvs.2006.06.013

Cited by 143 publications

(109 citation statements)

References 19 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…The first involves a hybrid procedure in which extra-anatomic bypasses are created to perfuse the visceral and renal vessels from the iliac arteries, followed by relining of the aorta with stent grafts. [21][22][23][24][25][26] An alternative approach, which relies solely on endovascular techniques, has been described with 2 different types of devices. The first utilizes fenestrations, or controlled holes in the fabric or the prosthesis, that are aligned and then adjoined to the respective visceral artery orifice with a balloon-expandable stent graft.…”

Section: Development Of Endovascular Aortic Repairmentioning

confidence: 99%

Endovascular Repair of Thoracoabdominal Aneurysms

2008

View full text Add to dashboard Cite

Background-Morbidity and mortality after conventional repair of thoracoabdominal aneurysms remain high. Alternative techniques have been proposed and are the subject of this report. Methods and Results-Endovascular grafts that have a means of incorporating the visceral vessels into the aortic repair were divided into devices with fenestrations and those with formal branches. Hybrid procedures whereby an extra-anatomic bypass procedure is used to provide inflow to the renal and mesenteric arteries followed by aortic relining with stent grafts were reviewed and tabulated. A description of the techniques and review of the current results are provided. Only 4 series with Ͼ10 cases of hybrid procedures have been published. The experience with such a procedure suggests feasibility, but most reports describe a persistently high risk of mortality (up to 25%). Larger series of fenestrated stent grafts to treat juxtarenal aneurysms have been published, and intermediate-term results confirm the safety and efficacy of the procedure. A larger multicenter trial is under way. Other pure endovascular methods have been used to treat thoracoabdominal aneurysms with both reinforced fenestrations and directional branches. Without counting small series (Ͻ10 cases), 2 series exist with Ϸ100 cases that noted perioperative mortality rates between 3% and 6%, without evidence of late ruptures. Conclusions-Endovascular repair of thoracoabdominal aneurysms is feasible and is associated with relatively low perioperative mortality. Several methods of visceral vessel incorporation have been described. Because of persistently high mortality, hybrid procedures will likely be relegated to nonsurgical and nonendovascular patients with sizable aneurysms. Endografts with branches continue to evolve and will be assessed in the context of clinical trials.

show abstract

Section: Development Of Endovascular Aortic Repairmentioning

confidence: 99%

Endovascular Repair of Thoracoabdominal Aneurysms

2008

View full text Add to dashboard Cite

show abstract

“…4,6,9,12 Contemporary endovascular treatment lets the surgeon occlude the entry site using the stent grafts. 5,9,10 When choosing endovascular treatment of type B aortic dissection, implantation criteria must be fulfilled, determining treatment success. In acute type B aortic dissections, open surgery may be necessary to lengthen the neck of the dissecting the aneurysm, transposing the left carotid artery to the right carotid artery, or performing in extra-anatomic bypass from the brachiocephalic trunk to the left common carotid artery.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,10 It leads to the collapse of the false lumen, and a final partial or complete false lumen thrombosis. 11 Most entry tears are located at the origin of the left subclavian artery.…”

Section: Introductionmentioning

confidence: 99%

“…This is referred to as a hybrid approach, involving bypassing of the arteries arising from the aortic arch during an open surgery after implanting an endovascular stent graft. 10 The endovascular technique interferes with the basic mechanism leading to aortic dissection, as it initiates 3 Mariusz Chabowski the natural repair processes: false lumen thrombosis. 12 As a result of covering the entry, false lumen blood flow pressure decreases.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Untitled

2014

Exp Clin Transplant

View full text Add to dashboard Cite

This study describes our experiences with a 44-yearold woman who developed acute type B aortic dissection and elected emergency surgery 3 years after a renal transplant. This led to acute ischemia in the right lower extremity. The first stage of surgery was to implant an extra-anatomic (pretracheal) bypass with a GORE-TEX prosthesis from the brachiocephalic trunk to the left common carotid artery. The second stage was implanting a stent graft into the aortic arch that covered the left common carotid artery and the left subclavian artery. The third stage was to insert a stent graft that involved the entire thoracic aorta and proximal segment of the abdominal aorta to the celiac trunk, with the right axillary and left femoral approach. The fourth stage was an extra-anatomic (suprapubic) bypass with the GORE-TEX prosthesis from the left femoral artery to the right femoral artery. Surgery resulted in normal blood supply to the organs and restored renal function.

show abstract

“…Some procedures requiring landing zone 2 or 3 may be carried out after the completion of extra-anatomic bypasses to the head vessels with subsequent endoluminal stentgrafting, without sternotomy and open debranching (52).…”

Section: The Techniquesmentioning

confidence: 99%

Open repair techniques in the aortic arch are still superior

Bachet¹

2018

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Conventional arch replacement can be carried out in a great majority of patients. Hybrid procedures are often as invasive and technically difficult as conventional ones. Moreover, their immediate results are, in many reported experiences, not better and their long-term results less favourable than the ones observed with conventional methods. So, yes, the open conventional arch replacement is still "the gold standard".

show abstract

Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: Surgical challenges and clinical outcomes

Cited by 143 publications

References 19 publications

Endovascular Repair of Thoracoabdominal Aneurysms

Endovascular Repair of Thoracoabdominal Aneurysms

Untitled

Open repair techniques in the aortic arch are still superior

Contact Info

Product

Resources

About