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Hybrid open-endoluminal technique for repair of thoracoabdominal aneurysm involving the celiac axis
M Lawrence-Brown1, K Sieunarine, G van Schie
1Department of Vascular Surgery, Royal Perth Hospital, Western Australia, Australia.
Insights
This study presents a novel combined endovascular and open surgical technique for repairing thoracoabdominal aneurysms. The method successfully excluded aneurysms in two patients with complex anatomy and limited cardiac reserve.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Aneurysm Repair
Background:
- Thoracoabdominal aneurysms (TAAs) pose significant surgical challenges, particularly in patients with compromised cardiac reserve.
- Traditional open repair carries high morbidity and mortality in this patient population.
- Endovascular techniques offer less invasive options but achieving a secure distal seal can be difficult in TAA repair.
Observation:
- A hybrid technique combining endoluminal stent-graft implantation with an open surgical approach was employed in two patients with Type I TAA.
- The endograft's distal seal was reinforced with a Dacron band sutured to the aorta via a midline incision.
- The patent celiac artery was ligated to prevent retrograde sac filling.
Findings:
- Both patients tolerated the procedure well, with no perioperative complications.
- Follow-up imaging confirmed successful aneurysm exclusion in both cases.
- At three years post-procedure, both patients remained free of endoleak or device migration, indicating durable repair.
Implications:
- This combined endovascular and open surgical approach provides a viable treatment option for complex thoracoabdominal aneurysms.
- It is particularly beneficial for patients with unsuitable anatomy for purely endovascular repair and those with limited cardiac reserve.
- The technique offers a potentially safer alternative to conventional open surgery for selected TAA patients.
Purpose:
To describe a technique combining endoluminal and open approaches for the repair of thoracoabdominal aneurysms involving the celiac axis.
Case Report:
Two patients with type I thoracoabdominal aneurysm and suboptimal cardiac reserve underwent transluminal stent-graft implantation. To achieve satisfactory distal seal, the caudal end of the endograft was circumscribed with a Dacron band that was sutured to the aorta and endograft through a midline incision. The patent celiac artery in both patients was ligated to stop retrograde filling of the aneurysm sac. The patients developed no problems perioperatively, and exclusion of the aneurysms was confirmed by follow-up imaging. Three years after endografting, both patients had excluded aneurysms without evidence of endoleak or device migration.
Conclusions:
This combined approach is another treatment option for thoracic aneurysms that have an anatomically suitable proximal attachment zone with a compromised distal neck.
