Long-Term Outcomes of Hybrid Treatment for Thoracoabdominal Aortic Aneurysms: A 19-year Single-Center Experience.

BACKGROUND: Open surgical repair for thoracoabdominal aortic aneurysms (TAAAs) is associated with substantial perioperative morbidity and mortality, especially in elderly or comorbid patients. Hybrid repair-visceral debranching combined with thoracic endovascular aortic repair-was introduced at our institution in 2007 to reduce operative stress while maintaining durable outcomes. This study evaluates the long-term results of this approach over a 19-year experience.

METHODS: We retrospectively analyzed 78 patients who successfully underwent hybrid TAAA repair and were discharged between 2007 and 2025. Long-term outcomes focused on aneurysm-related events and the need for reintervention.

RESULTS: Fifty-four patients (69.2%) were male, with a mean age of 73 years (range, 44-89). Twenty-two patients (28.2%) were ≤70 years, 26 (33.3%) were in their seventies, and 30 (38.5%) were in their eighties. Overall survival was 67.0% ± 5.4% at 5 years and 30.9% ± 6.3% at 10 years. Freedom from aneurysm-related events was 98.5% ± 1.5% at 5 years and 77.2% ± 9.4% at 10 years. Freedom from reintervention was 85.0% ± 4.6% at 5 years and 54.8% ± 10.0% at 10 years. Aneurysm enlargement occurred in 29 patients (41.4%), and 17 patients (21.8%) underwent reintervention for endoleaks (type I: 5, type II: 4, type III: 8). Endoleak was the only factor significantly associated with aneurysm enlargement.

CONCLUSION: Despite the need for late reintervention, hybrid repair provides a high aneurysm-related event-free rate at 10 years when endoleaks are appropriately managed. Hybrid repair remains a valuable treatment option for high-risk patients, particularly in centers without full endovascular capability and in patients who are anatomically unsuitable for total endovascular repair.