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Updated: Jun 6, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Hybrid procedures for complex thoracic aortic diseases
José Carlos Ingrund1, Felipe Nasser, Seleno Glauber de Jesus-Silva
1Serviço de Angiorradiologia e Cirurgia Vascular, Hospital Santa Marcelina, SP, Brazil.
Insights
Hybrid procedures offer a feasible alternative for complex thoracic aortic diseases (CTAD), demonstrating good outcomes in high-risk patients. This integrated surgical and endovascular approach reduces morbidity and mortality compared to traditional surgery.
Area of Science:
- Cardiovascular Surgery
- Endovascular Interventions
- Thoracic Aortic Disease Management
Background:
- Complex thoracic aortic diseases (CTAD) often necessitate revascularization of supra-aortic arteries.
- Hybrid procedures combine surgical and endovascular techniques for CTAD treatment.
- These hybrid approaches aim to reduce morbidity and mortality compared to conventional open surgery.
Purpose of the Study:
- To evaluate the technique and outcomes of hybrid procedures for complex thoracic aortic diseases (CTAD).
Main Methods:
- A cohort of 12 patients with CTAD underwent hybrid procedures over two years.
- Procedures included aortic arch aneurysms and acute Stanford A and B aortic dissections.
- Patients had inadequate proximal landing zones, and 75% had at least three cardiovascular risk factors.
Main Results:
- Initial technical success was achieved in 10 patients (83%).
- Two early deaths (within 30 days) occurred; no major complications like paraplegia, stroke, or renal failure were reported.
- No endoprosthesis migration or need for emergency surgical conversion was observed.
Conclusions:
- Hybrid treatment for CTAD is a feasible and effective option, particularly for high-risk individuals.
- The integration of surgical and endovascular methods, coupled with surveillance, presents a viable alternative to conventional surgery.
- This approach shows promise in managing complex aortic conditions with potentially lower risks.
Background:
Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery.
Objectives:
To evaluate the technique and results of hybrid procedures for CTAD.
Methods:
During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans.
Results:
The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. Two deaths occurred in the first 30 days after the procedure. No endoprosthesis migration was observed. No patient had paraplegia, stroke, renal failure, bleeding or coagulopathy, elective or emergency surgical conversion.
Conclusion:
Hybrid treatment of CTAD is feasible, especially in high risk patients. Proper integration of surgical and endovascular techniques, in addition to clinical and radiological surveillance, makes this technique a great alternative to conventional surgery.
