Hybrid Approaches for Aortic Disease-Our Experience

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Arch Repair

Background:

• The aortic arch presents significant challenges for endovascular repair due to its complex anatomy.
• Hybrid thoracic endovascular aortic repair (TEVAR) serves as an alternative to traditional open total arch replacement.
• Technological advancements continue to evolve for endovascular aortic repair.

Purpose of the Study:

• To evaluate the outcomes of hybrid TEVAR in the aortic arch.
• To assess the feasibility and safety of this approach for complex aortic arch anatomies.
• To determine mid-term and long-term results of hybrid TEVAR in the aortic arch.

Main Methods:

• Retrospective case series of 71 patients undergoing hybrid TEVAR in the aortic arch over 12 years.
• Analysis of procedural outcomes, including morbidity and mortality.
• Follow-up imaging to assess for complications such as endoleak and graft stenosis.

Main Results:

• 30-day major morbidity was 15.7% (stroke, paraplegia, pulmonary complications).
• 30-day mortality was 5.2% due to respiratory failure in a patient with comorbidities.
• Mean follow-up of 30 months showed sustained 5.2% overall mortality, with one case of retrograde type A dissection and two endoleaks.

Conclusions:

• Single-stage hybrid TEVAR in the aortic arch is technically feasible.
• The procedure offers good mid-term survival rates.
• Long-term freedom from reintervention is achievable with this hybrid approach.