Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2012
Hybrid repair with antegrade visceral artery debranching: the preferred treatment option for thoracoabdominal aneurysms in high-risk patients.
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Markatis Fotis, Petrosyan Andranyk, Abdulamit Timur, Bergeron Patrice
Аннотация
PURPOSE: To present a hybrid repair technique that may decrease the morbidity and mortality associated with thoracoabdominal aneurysm (TAAA) repair, especially in high-risk patients.
METHODS: A retrospective analysis was performed of patients treated for TAAA at a single institution from 2005 to 2010. Nine patients (8 men; mean age 72 years) with Crawford types II or IV TAAAs were treated with a 2-stage hybrid technique consisting of antegrade visceral debranching of the aorta, followed within a month by endovascular deployment of endografts to cover the entire diseased aortic segment.
RESULTS: There was no perioperative mortality, paraplegia, or permanent renal failure. Following the debranching procedure, there were 4 cases of transient renal dysfunction, 1 minor stroke (resolved), and 1 low-flow pancreatic fistula that regressed. There were no complications after the endovascular repair. Over a mean follow-up of 28 months (range 8-50), all patients are alive, with good patency of the bypass grafts and endografts. One late type II endoleak is under surveillance.
CONCLUSION: This small series shows that the ascending aorta is a safe location for antegrade visceral debranching, which could facilitate hybrid repair in most cases, especially those patients with advanced lesions of the iliac arteries. More patients and longer follow-up are required to draw definite conclusions for the adoption of this treatment in high-risk patients.
METHODS: A retrospective analysis was performed of patients treated for TAAA at a single institution from 2005 to 2010. Nine patients (8 men; mean age 72 years) with Crawford types II or IV TAAAs were treated with a 2-stage hybrid technique consisting of antegrade visceral debranching of the aorta, followed within a month by endovascular deployment of endografts to cover the entire diseased aortic segment.
RESULTS: There was no perioperative mortality, paraplegia, or permanent renal failure. Following the debranching procedure, there were 4 cases of transient renal dysfunction, 1 minor stroke (resolved), and 1 low-flow pancreatic fistula that regressed. There were no complications after the endovascular repair. Over a mean follow-up of 28 months (range 8-50), all patients are alive, with good patency of the bypass grafts and endografts. One late type II endoleak is under surveillance.
CONCLUSION: This small series shows that the ascending aorta is a safe location for antegrade visceral debranching, which could facilitate hybrid repair in most cases, especially those patients with advanced lesions of the iliac arteries. More patients and longer follow-up are required to draw definite conclusions for the adoption of this treatment in high-risk patients.