Hybrid open endovascular technique for aortic thoracoabdominal pathologies

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Hybrid debranching strategies for thoracoabdominal pathologies have yielded mixed results.
• Initial enthusiasm for the technique has been tempered by criticism and ambiguity.
• This meta-analysis evaluates the safety and efficacy of hybrid repair for thoracoabdominal aortic aneurysms.

Purpose of the Study:

• To assess the safety and efficacy of hybrid debranching repair for thoracoabdominal aortic pathologies.
• To provide a pooled analysis of technical success, complication rates, and mortality.
• To inform clinical decision-making for patients with complex aortic conditions.

Main Methods:

• A comprehensive electronic search identified publications on hybrid open endovascular repair.
• Meta-analyses were performed for key outcomes including technical success, graft patency, and complications.
• Nineteen publications involving 507 patients were analyzed.

Main Results:

• Pooled technical success was 96.2% and visceral graft patency was 96.5%.
• Spinal cord ischemia symptoms occurred in 7.5% (paraplegia 4.5%), and renal failure in 8.8%.
• 30-day/in-hospital mortality was 12.8%, with a 22.7% endoleak rate during follow-up.

Conclusions:

• Hybrid repair for thoracoabdominal pathologies in high-risk patients is associated with substantial morbidity and mortality.
• The technique's efficacy may require further refinement and improvement.
• Careful patient selection is crucial given the associated risks.