ABSTRACT
Combined retrograde open visceral revascularization and endovascular exclusion for the treatment of thoracoabdominal aortic aneurysms [TAAA]. It is a retrospective review of a prospectively collected database of 11 consecutive patients [4 women], with a median patient age of 71 years [range 41 to 77 years]. All patients underwent hybrid reconstruction of thoracoabdominal aortic aneurysms [Crawford type II in 3 and type III in 8 patients] in the period between November 2006 and November 2007. Seven patients underwent elective repair, 3 patients were symptomatic and underwent urgent repair, and 1 patient had an emergency repair for rupture. Previous aortic surgery had been performed in 3 patients. One or more severe comorbidities were present in 82% of patients [9/11]; six patients had moderate to severe respiratory insufficiency, 4 patients had moderate to severe left ventricular dysfunction, and 5 patients had chronic renal impairment. One patient had Marfan's syndrome. A total of 40 visceral bypasses were performed; these included 11 to the superior mesenteric artery [SMA], 11 to the celiac trunk [CA] and 18 renal artery [RA] bypasses [bilateral in 7 patients and single in 4]. Aneurysm exclusion was achieved with a median of 2 stent-grafts per patient. Paraplegia did not occur in any patient. The 30-day mortality was 18% [2/11 patients]. Two patients [18%] required re-intubation and respiratory support following initial extubation, 4 patients [36.5%] required inotropic support, and 2 patients [18%] required temporary renal support for <5 days. The hybrid reconstruction was performed as a one stage operation in 7/11 patients. All operations were completed. Median operative time was 7 hours [5.5 to 9.5 hours]. Median lengths of ITU stay and total hospital stay were 9 days and 22 days respectively. Postoperative CT at 1 week revealed no type 1 endoleaks in any patients and 4 cases of type II endoleak and a 100% graft patency. During a median follow-up of 13 weeks [range, 1 to 54 weeks] there was no aneurysm expansion and all grafts remained patent. Preliminary results of hybrid reconstruction of Crawford types II and III thoracoabdominal aortic aneurysms show technical feasibility and low paraplegia rates. Until longer follow-up is available, in terms of stent durability and extra-anatomical bypass graft-related complications, the hybrid procedure should be reserved for high surgical risk patients unfit for open repair