Hybrid procedure for treatment of thoracoabdominal aortic aneurysms (TAAA). Initial experience in a high-risk population
Introduction. Open replacement of the aorta for treatment of thoracoabdominal aortic aneurysms (TAAA) is liable to complications. The combination therapy consisting in endovascular bypass of the TAAA and proximal/distal diversion of supraaortal vessels and of the visceral and renal arteries (debranching) could be a technical alternative for the high-risk patient. Patients and methods. We report on a consecutive prospective series of 47 patients with TAAA (29.8% female; median age 65.5 years, range 37-81 years; 44 in ASA stage > 3). In 51% of cases the aneurysm was an arteriosclerotic TAAA, while in 38.3% a secondarily expanding type B aortic dissection was present and in 10.6%, a plaque rupture or a Carrel patch stretched by an aneurysm. Results. The 30-day mortality was 12.6% (6/47 patients) for the whole series and 7.4% 3/41) for those with nonruptured TAAA. The corresponding paraparesis/paraplegia rates were 4.2% and 8.5%. In 8.5% renal insufficiency requiring dialysis arose in the postoperative period. The mean length of stay in hospital was 21.3-26 (11-68)days and the mean length of stay in the intensive care unit, 9 (2- 31)days. Conclusions. The hybrid operation is a technically and logistically challenging alternative to conventional thoracoabdominal aortic replacement for the high risk patient. To optimise the result, the procedure must be evaluated prospectively against the conventional standard treatment.