[Etiological analysis and treatment of the complications of hybrid procedure in the treatment of aortic arch diseases].

OBJECTIVE

To analyze the reasons of complications after hybrid procedure in the treatment of aortic arch diseases.

METHODS

Data from 34 consecutive patients (28 male and 6 female) of aortic arch diseases treated with hybrid procedure between January 2001 and December 2008 was analyzed retrospectively. The mean age of the patients was 56.7 years (ranged from 34 to 75 years). Of the 34 patients, 27 were aortic dissections (21 cases of Stanford type A dissections and 6 cases of Stanford type B dissections) and 7 were aortic arch aneurysms. Hybrid procedure included ascending aorta (AA)-innominate artery-left common carotid artery (LCCA) bypass (n = 3), AA-LCCA-left subclavian artery (LSA) bypass (n = 2), AA-LCCA bypass and coronary artery bypass (n = 1), LCCA-right common carotid artery (RCCA) bypass (n = 13), RCCA-LCCA and LCCA-LSA bypass (n = 3), LSA-LCCA-RCCA bypass (n = 2) and LCCA-LSA bypass (n = 9). All the patients received single stage (n = 26) or staged (n = 8) endovascular repairs.

RESULTS

The complications occurred in 32.4% (11/34), with 11.8% (4/34) of all patients having lethal complications. The complications included 1 case of rupture of aortic dissection (2.9%), 2 cases of stroke (5.9%), 2 cases of stomal leak and pseudoaneurysm (5.9%), 1 case of myocardial infarct (2.9%), 1 case of pulmonary embolism (2.9%), 1 case of neck hematoma (2.9%) and 3 cases of endoleak (8.8%). In the period of follow-up (6 to 50 months), all patients were alive except for 4 perioperative deaths.

CONCLUSIONS

Complication rate of hybrid procedure in the treatment of aortic arch diseases is higher than that of simple endovascular repair of descending aortic diseases. Reducing the lethal complications is the key to disseminate this technique.