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Updated: Aug 21, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation
Thierry P Carrel1, Pascal A Berdat, Iris Baumgartner
1Clinic for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. thierry.carrel@insel.ch
Insights
This study presents a novel combined surgical and endovascular approach for complex aortic coarctation. This innovative technique successfully treated a recurrent case without cardiopulmonary bypass, offering a less invasive option.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Complex coarctation of the aorta, including recoarctation and hypoplastic aortic arch, presents significant therapeutic challenges.
- Traditional surgical repair methods are technically demanding and associated with substantial perioperative risks.
- The utility of stent technology in managing these complex aortic lesions remains undefined.
Observation:
- A 21-year-old female patient with recurrent coarctation of the aorta, hypoplastic aortic arch, and descending aorta pseudoaneurysm was previously treated with four interventions.
- The patient presented with a complex aortic pathology requiring a novel treatment strategy.
Findings:
- A combined surgical and endovascular approach was successfully employed, avoiding cardiopulmonary bypass and deep hypothermic circulatory arrest.
- The procedure involved extraanatomic aortic bypass, partial debranching of supraaortic vessels, and stent-graft insertion to exclude the pseudoaneurysm.
- This minimally invasive strategy effectively addressed the complex aortic anatomy.
Implications:
- This case demonstrates the feasibility and potential of a hybrid approach for complex aortic coarctation and associated pathologies.
- The findings suggest that stent-graft technology, combined with surgical techniques, can offer a viable alternative to traditional open repairs.
- This approach may reduce perioperative risks and improve outcomes for patients with recurrent or complex aortic coarctation.
Abstract:
Various therapeutic approaches have been proposed to treat complex coarctation of the aorta (eg, recoarctation, which requires repetitive interventions, or coarctation with a hypoplastic aortic arch). Resection followed by end-to-end anastomosis or by graft interposition is technically demanding and exposes the patient to considerable perioperative risks. Cardiopulmonary bypass and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. The role of stent technology in treating this type of lesion has not yet been defined. We present a 21-year-old woman with a recurrent coarctation of the aorta associated with a hypoplastic aortic arch and a pseudoaneurysm of the proximal descending aorta. She had undergone 4 previous interventions. Treatment consisted of a combined surgical and endovascular approach without cardiopulmonary bypass and included extraanatomic aortic bypass, partial debranching of the supraaortic vessels, and stent-graft insertion to exclude the aneurysm.
