Supra-aortic hybrid endovascular procedures for complex thoracic aortic disease: single center early to midterm results.

BACKGROUND: Hybrid technique with open surgical supra-aortic extra-anatomical bypasses (to provide a suitable proximal landing zone) and simultaneous or staged thoracic endovascular stent grafting is less invasive than open surgery in the treatment of complex aortic arch pathology. The aim of this study is to report our hybrid experience.

METHODS: Retrospective review of prospectively collected computerized database. All patients had regular clinical and radiological computed tomography follow-up.

RESULTS: Sixteen patients (13 males and 3 females) with mean age of 64.8 (range 51-79) were treated with hybrid techniques between May 2005 and September 2007. There were nine elective, two urgent (within 2 weeks of presentation), and five emergency cases. Thirteen patients had arch or proximal descending thoracic aortic aneurysms, and six patients had aortic dissections. All extra-anatomical bypasses were performed simultaneously with stent grafts, with mean operating time of 331.2 (range 195-540) minutes. Eight patients had right to left carotid-carotid cross-over graft, five had bifurcating grafts from ascending aorta to innominate and left carotid artery, two had left carotid to left subclavian artery, and one had left carotid to aberrant right subclavian bypass graft. All patients had Cook Zenith thoracic stent grafts. Deployment success was 100%, with no endoleak on completion angiogram. There was no mortality. Three patients had postoperative nondebilitating stroke and no paraplegia. The mean follow-up was 14 (range 1-27) months. One reintervention was required, and two patients had type II endoleak treated conservatively.

CONCLUSION: Supra-aortic hybrid procedures in treating aortic arch pathology are safe and effective, and early- to midterm results are encouraging.