Endovascular repair has gradually become the mainstream treatment of aortic dilatation disease. However, endovascular therapy requires sufficient landing zone both in the proximal and distal region of aortic lesion. A large proportion of aortic dilatation lesion was excluded from traditional endovascular therapy due to the visceral artery involvement or being too close to the orifice of viceral artery. Recently, with the adoption of chimney technique, sandwich technique and hybrid technique and the advent of fenestrated and branched stent graft expand the application of endovascular repair technology, rendering these specific type of aortic disease gradually got the chance to endovascular surgery. Different technology has its own characteristics and scope. The surgeons should make their own judgment and selection based on the specific characteristics of lesions, their experience and accessibility to special equipment and other related factors.
Aorta ; pathology ; Aortic Diseases ; surgery ; Aortography ; Arteries ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo evaluate the effect of extensive aortic diseases (EAD) after hybrid repair with supra-arch branches or visceral arterial debranching and endovascular repair.

METHODSA total of 24 EAD patients (19 male and 5 female) underwent hybrid repair in Department of Vascular Surgery, Zhongshan Hospital, Fudan University between March 2005 and April 2015. The clinical data was analyzed retrospectively. The mean age was (49±12) years (from 29 to 69 years). The high-risk candidates for open surgery were enrolled in the study. The patients, including 14 cases with thoracic aortic aneurysms and 10 cases with aortic dissection, were treated by one or two stages. Post-operative follow-up with CT angiography was performed at 3, 6 and 12 months and then annually thereafter.

RESULTSA total of 74 branches, including 63 with visceral arteries and 11 with supra-arch arteries, were recanalized. Nine patients were treated in two-stage hybrid procedure and fifteen were repaired by one stage. The perioperative mortality was 12.5% (3/24), whereas the aneurysm-related mortality was 8.3% (2/24). The 30-day patency of the grafts was 95.9% (71/74). There was no endoleak, paralysis, and intestinal ischemia at 30 days post-hybrid procedures. Four cases (16.6%) suffered acute renal dysfunction. During the follow-up (3 to 123 months), there were two deaths and one endoleak (type Ia and III) which emerged at 4 months post-procedure. The 1-year and 3-year survival rates were 81.7% and 73.5%, respectively.

CONCLUSIONSHybrid treatment is safe and effective for complex EAD patients in the midterm follow-up. It is especially suitable for the high-risk patients with comorbidities, re-intervention, or little tolerance to open surgery repair.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Angiography ; Aorta ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Aortic Diseases ; surgery ; Blood Vessel Prosthesis Implantation ; Endoleak ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome