Combined Endovascular and Open Revascularization

Unusual hybrid repair of a thoracoabdominal and mesenteric aneurysm with aberrant right hepatic artery

Hybrid approaches for the treatment of thoracoabdominal aortic aneurysms that combine visceral debranching and endovascular repair are feasible alternatives to open surgery for certain high-risk patients. A 70-year-old man was admitted with a rapidly expanding thoracoabdominal aneurysm involving the superior mesenteric artery, associated with an aberrant hepatic artery. An iliovisceral debranching was performed, followed by the endovascular repair of the thoracoabdominal aorta with a standard thoracic device. The ostial aneurysm was excluded by retrograde implantation of a covered stent from the superior mesenteric artery. Such approach can be considered as a viable alternative in the management of complex thoracoabdominal aneurysms.

The Role of Hybrid Procedures in the Management of Peripheral Vascular Disease

This paper provides a summary of up-to-date information and experience with the combined treatment of patients suffering from peripheral arterial disease (PAD) with endovascular and open surgery, performed simultaneously and in a single operating room. Hybrid intervention is reported to have good results in well-indicated groups of patients with acute and chronic limb ischemia, even with older, high-risk patients. The indications for the use of this technique remain unclear with inconsistent opinions among vascular surgeons. The indications for treatment were divided into three main groups: 1) Patients with chronic limb ischemia, 2) acute limb ischemia, and 3) occlusion of a previous vascular reconstruction. The operating techniques for the most commonly used combinations are described.

In conclusion, hybrid operating techniques are often useful when treating complex problems and multilevel disease in patients with chronic or acute lower limb ischemia. Modern vascular surgeons need to master both open and endovascular techniques, and to combine them in a creative fashion to the benefit of our patients.

The New Era of Cardiac Surgery Hybrid Therapy for Cardiovascular Disease

Surgical therapy for cardiovascular disease carries excellent long-term outcomes but it is relatively invasive. With the development of new devices and techniques, modern cardiovascular surgery is trending toward less invasive approaches, especially for patients at high risk for traditional open heart surgery. A hybrid strategy combines traditional surgical treatments performed in the operating room with treatments traditionally available only in the catheterization laboratory with the goal of offering patients the best available therapy for any set of cardiovascular diseases. Examples of hybrid procedures include hybrid coronary artery bypass grafting, hybrid valve surgery and percutaneous coronary intervention, hybrid endocardial and epicardial atrial fibrillation procedures, and hybrid coronary artery bypass grafting/carotid artery stenting. This multi-disciplinary approach requires strong collaboration between cardiac surgeons, vascular surgeons, and interventional cardiologists to obtain optimal patient outcomes.