[Clinical analysis of hybrid treatment for extensive aortic disease]

To evaluate the effect of extensive aortic diseases (EAD) after hybrid repair with supra-arch branches or visceral arterial debranching and endovascular repair.

A total of 24 EAD patients (19 male and 5 female) underwent hybrid repair in Department of Vascular Surgery, Zhongshan Hospital, Fudan University between March 2005 and April 2015. The clinical data was analyzed retrospectively. The mean age was (49±12) years (from 29 to 69 years). The high-risk candidates for open surgery were enrolled in the study. The patients, including 14 cases with thoracic aortic aneurysms and 10 cases with aortic dissection, were treated by one or two stages. Post-operative follow-up with CT angiography was performed at 3, 6 and 12 months and then annually thereafter.

A total of 74 branches, including 63 with visceral arteries and 11 with supra-arch arteries, were recanalized. Nine patients were treated in two-stage hybrid procedure and fifteen were repaired by one stage. The perioperative mortality was 12.5% (3/24), whereas the aneurysm-related mortality was 8.3% (2/24). The 30-day patency of the grafts was 95.9% (71/74). There was no endoleak, paralysis, and intestinal ischemia at 30 days post-hybrid procedures. Four cases (16.6%) suffered acute renal dysfunction. During the follow-up (3 to 123 months), there were two deaths and one endoleak (type Ia and III) which emerged at 4 months post-procedure. The 1-year and 3-year survival rates were 81.7% and 73.5%, respectively.

Hybrid treatment is safe and effective for complex EAD patients in the midterm follow-up. It is especially suitable for the high-risk patients with comorbidities, re-intervention, or little tolerance to open surgery repair.