A Gkremoutis1, T Schmandra1, M Meyn1, T Schmitz-Rixen1, M Keese2. 1. Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany. 2. Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany. Electronic address: michael.keese@kgu.de.
Abstract
OBJECTIVES: The aim was to report a single center experience with hybrid procedures in the emergency treatment of patients with thoracoabdominal aortic pathology. Thoracoabdominal aortic aneurysm (TAAA) repair is primarily conducted by conventional surgery in the urgent and emergency setting. The role of hybrid procedures with stent graft coverage of the aorta and extra-anatomical debranching of the renovisceral arteries has so far not been defined in this context. METHODS: From 2007 to 2013 30 patients (21 males, 9 females) undergoing an emergent or urgent TAAA hybrid procedure were included in a data register. The mean aneurysm diameter was 72 mm. Etiology was atherosclerosis in 23 patients (76.7%) and aortic dissection in seven patients (23.3%). Nineteen patients (63.3%) required emergency surgery. In 11 cases (36.7%), surgery was indicated for symptomatic aneurysms. Mean follow-up was 16 months (range 1-72 months). RESULTS: The hybrid procedure was completed in all patients. Renovisceral revascularization was performed with a total of 101 grafts (25 to the celiac, 30 to the superior mesenteric, 25 to the right renal, and 21 to the left renal artery). The 30-day and 1-year primary graft patency was 97.3% and 95.3% respectively. A median of three stent grafts per patient was deployed. One patient underwent surgical intervention for early endoleak (3.3%). Three patients (10%) developed spinal ischemia with persistent paraplegia. Two patients (6.7%) required chronic hemodialysis. Thirty-day mortality reached 26.7% (N = 8), being 36.8% in emergency patients (7 of 19) and 9.1% in the urgent group (1 of 11 patients). The cumulative postoperative survival rate after 12 months was 57.8%. CONCLUSIONS: Hybrid procedures have the potential to be an alternative treatment option for complex thoracoabdominal pathology in the urgent and emergency setting. The procedure is readily available and enables adequate surgical repair with enduring results. Nevertheless it is still associated with significant mortality and morbidity.
OBJECTIVES: The aim was to report a single center experience with hybrid procedures in the emergency treatment of patients with thoracoabdominal aortic pathology. Thoracoabdominal aortic aneurysm (TAAA) repair is primarily conducted by conventional surgery in the urgent and emergency setting. The role of hybrid procedures with stent graft coverage of the aorta and extra-anatomical debranching of the renovisceral arteries has so far not been defined in this context. METHODS: From 2007 to 2013 30 patients (21 males, 9 females) undergoing an emergent or urgent TAAA hybrid procedure were included in a data register. The mean aneurysm diameter was 72 mm. Etiology was atherosclerosis in 23 patients (76.7%) and aortic dissection in seven patients (23.3%). Nineteen patients (63.3%) required emergency surgery. In 11 cases (36.7%), surgery was indicated for symptomatic aneurysms. Mean follow-up was 16 months (range 1-72 months). RESULTS: The hybrid procedure was completed in all patients. Renovisceral revascularization was performed with a total of 101 grafts (25 to the celiac, 30 to the superior mesenteric, 25 to the right renal, and 21 to the left renal artery). The 30-day and 1-year primary graft patency was 97.3% and 95.3% respectively. A median of three stent grafts per patient was deployed. One patient underwent surgical intervention for early endoleak (3.3%). Three patients (10%) developed spinal ischemia with persistent paraplegia. Two patients (6.7%) required chronic hemodialysis. Thirty-day mortality reached 26.7% (N = 8), being 36.8% in emergency patients (7 of 19) and 9.1% in the urgent group (1 of 11 patients). The cumulative postoperative survival rate after 12 months was 57.8%. CONCLUSIONS: Hybrid procedures have the potential to be an alternative treatment option for complex thoracoabdominal pathology in the urgent and emergency setting. The procedure is readily available and enables adequate surgical repair with enduring results. Nevertheless it is still associated with significant mortality and morbidity.
Authors: Manuel Alonso Pérez; José Manuel Llaneza Coto; José Antonio Del Castro Madrazo; Carlota Fernández Prendes; Mario González Gay; Amer Zanabili Al-Sibbai Journal: J Thorac Dis Date: 2017-05 Impact factor: 2.895
Authors: Salvatore T Scali; Dan Neal; Vida Sollanek; Tomas Martin; Julie Sablik; Thomas S Huber; Adam W Beck Journal: J Vasc Surg Date: 2015-08-05 Impact factor: 4.268