"Hybrid" Approach for the Treatment of Aortic Arch Aneurysm
Background: High mortality and morbidity rates are associated with the conventional surgery for aortic arch aneurysm because of cardiopulmonary bypass and deep hypothermic circulatory arrest. In this report, we describe a "hybrid" treatment for aortic arch aneurysm that combines the surgical debranching procedure and the stenting technique.
Methods: A surgical bypass graft is created from the ascending aorta to every main branch of the aortic arch. Subsequently, an endovascular stent graft is deployed retrogradely through the femoral artery with the aid of digital subtraction angiography.
Result: The patient was discharged on postoperative day 7. A computed tomography scan was routinely performed at 1 week postoperatively to confirm the good patency of all grafts and the stent.
Conclusion: The feasibility and the benefit of the hybrid treatment for aortic arch aneurysm are confirmed.
Görich J, Asquan Y, Seifarth H, et al. 2002. Initial experience with intentional stent-graft coverage of the subclavian artery during endovascular thoracic aortic repairs. J Endovasc Ther 9(suppl 2):II39-43.nHausegger KA, Oberwalder P, Tiesenhausen K, et al. 2001. Intentional left subclavian artery occlusion by thoracic aortic stent-grafts without surgical transposition. J Endovasc Ther 8:472-6.nHughes GC, Nienaber JJ, Bush EL, Daneshmand MA, McCann RL. 2008. Use of custom Dacron branch grafts for "hybrid" aortic debranching during endovascular repair of thoracic and thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg 136:21-8.nRehders TC, Petzsch M, Ince H, et al. 2004. Intentional occlusion of the left subclavian artery during stent-graft implantation in the thoracic aorta: risk and relevance. J Endovasc Ther 11:659-66.nSchoder M, Grabenwöger M, Hölzenbein T, et al. 2006. Endovascular repair of the thoracic aorta necessitating anchoring of the stent graft across the arch vessels. J Thorac Cardiovasc Surg 131:380-7.nTiesenhausen K, Hausegger KA, Oberwalder P, et al. 2003. Left subclavian artery management in endovascular repair of thoracic aortic aneurysms and aortic dissections. J Card Surg 18:429-35.nWeigang E, Luehr M, Harloff A, et al. 2007. Incidence of neurological complications following overstenting of the left subclavian artery. Eur J Cardiothorac Surg 31:628-36.n