Hybrid approach to thoracic aortic aneurysm: The Lupiae technique

Aortic diseases, especially when the entire aorta is involved, are often challenging to treat since they frequently require invasive interventions. Minimally invasive hybrid treatment of such pathologies is proving to be a valid option for complex cases (for example, dilation involving the entire aorta) and is improving postoperative outcomes. It consists of a minimally invasive opening stage, where ascending aorta and aortic arch replacement and epiaortic vessel rerouting is performed using a multibranched graft equipped with a radiopaque marker. This is followed by an endovascular stage, where the remaining diseased aorta is covered with an endoprosthesis. This procedure has been described as Lupiae technique and the results seem encouraging.  In this tutorial, we give a practical overview of this technique, describing the treatment of a particular condition called mega-aorta syndrome type 1, which is the dilation of the aorta up to celiac trunk.