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Ilyas S, Stone DH, Powell RJ, Ponukumati AS, Kuwayama DP, Goodney PP, Columbo JA, Suckow BD. The financial burden associated with endovascular repair of thoracoabdominal and pararenal aortic aneurysms using physician-modified fenestrated-branched endografts. J Vasc Surg 2023; 78:1369-1375. [PMID: 37390850 DOI: 10.1016/j.jvs.2023.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE/BACKGROUND Endovascular thoracoabdominal and pararenal aortic aneurysm repair is more complex and requires more devices than infrarenal aneurysm repair. It is unclear if current reimbursement covers the cost of delivering this more advanced form of vascular care. The objective of this study was to evaluate the economics of fenestrated-branched (FB-EVAR) physician-modified endograft (PMEG) repairs. METHODS We obtained technical and professional cost and revenue data for four consecutive fiscal years (July 1, 2017, to June 30, 2021) at our quaternary referral institution. Inclusion criteria were patients who underwent PMEG FB-EVAR in a uniform fashion by a single surgeon for thoracoabdominal/pararenal aortic aneurysms. Patients in industry-sponsored clinical trials or receiving Cook Zenith Fenestrated grafts were excluded. Financial data were analyzed for the index operation. Technical costs were divided into direct costs that included devices and billable supplies and indirect costs including overhead. RESULTS 62 patients (79% male, mean age: 74 years, 66% thoracoabdominal aneurysms) met inclusion criteria. The mean aneurysm size was 6.0 cm, the mean total operating time was 219 minutes, and the median hospital length of stay was 2 days. PMEGs were created with a mean number of 3.7 fenestrations, using a mean of 8.6 implantable devices per case. The average technical cost per case was $71,198, and the average technical reimbursement was $57,642, providing a net negative technical margin of $13,556 per case. Of this cohort, 31 patients (50%) were insured by Medicare remunerated under diagnosis-related group code 268/269. Their respective average technical reimbursement was $41,293, with a mean negative margin of $22,989 per case, with similar findings for professional costs. The primary driver of technical cost was implantable devices, accounting for 77% of total technical cost per case over the study period. The total operating margin, including technical and professional cost and revenue, for the cohort during the study period was negative $1,560,422. CONCLUSIONS PMEG FB-EVAR for pararenal/thoracoabdominal aortic aneurysms produces a substantially negative operating margin for the index operation driven largely by device costs. Device cost alone already exceeds total technical revenue and presents an opportunity for cost reduction. In addition, increased reimbursement for FB-EVAR, especially among Medicare beneficiaries, will be important to facilitate patient access to such innovative technology.
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Affiliation(s)
- Sadia Ilyas
- Department of Vascular Surgery, Medstar Washington Hospital Center, Washington, DC
| | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard J Powell
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - David P Kuwayama
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jesse A Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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Hu X, Wang C, Liu J, Yang J, Yang F, Luo S, Lin W, Fan R, Luo J. Hybrid Technique Outcomes for High-Risk Uncomplicated Type B Aortic Dissection With Landing Zone 1. Am J Cardiol 2023; 205:104-110. [PMID: 37597485 DOI: 10.1016/j.amjcard.2023.07.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/21/2023]
Abstract
In this report, we analyzed the outcomes of the hybrid technique for high-risk uncomplicated type B aortic dissection with landing zone 1. We enrolled 80 patients from January 2016 to January 2020 and retrospectively analyzed their outcomes, including mortality, aortic-related adverse events, and aortic remodeling. The mean age was 51.6 ± 9.9 years, and 68.0% (54 of 80) were men. Technical success was achieved in 100% of cases (80 of 80), and 30-day mortality was 4% of patients (n = 3), including 2 dissection-related deaths. Immediate endoleaks occurred in 16 patients, including 11 type Ia and 5 type II. Four patients (5%) developed minor strokes postoperatively, and no short-term spinal cord ischemia and re-intervention occurred. The average length of stay was 20 ± 8 days. The overall mortality was 8% after a median follow-up of 44 months (38 to 52). Five patients (7%) developed strokes, and 11 (16%) had late endoleaks, including 1 type Ia, 5 type Ib, and 3 type II. Four re-interventions (5%) were necessary, 3 for endoleaks and 1 for retrograde type A dissection. Three bypass graft occlusions (5%) and 5 stoma stenoses (8%) were observed in the latest follow-up computed tomography. In conclusion, the hybrid technique with landing zone 1 might be a viable alternative to open aortic arch replacement in patients at high risk with uncomplicated type B aortic dissection with acceptable early and late outcomes. However, stroke and endoleak complications should be further addressed.
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Affiliation(s)
- Xiaolu Hu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Changjin Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jitao Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jue Yang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Department of Cardiovascular Surgery, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Fan Yang
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Songyuan Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Wenhui Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Ruixin Fan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Department of Cardiovascular Surgery, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
| | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
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3
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Premnath S, Hostalery A, Bungay P, Saggu G, Rowlands T, Singh S. Transrenal Endovascular Aneurysm Repair-A Novel Approach for Abdominal Aortic Aneurysms with Difficult Neck Anatomy. Ann Vasc Surg 2023; 96:186-194. [PMID: 37068625 DOI: 10.1016/j.avsg.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The endovascular approach to treating ruptured or symptomatic abdominal aortic aneurysms (AAAs) with difficult neck anatomy still poses a major challenge. This study proposes and evaluates the outcomes of a novel technique, Transrenal Endovascular Aneurysm Repair (Tr-EVAR) which utilizes the top ring 'valley' and 'peak' configuration of the Anaconda stent graft to achieve proximal seal in AAAs with an unfavourable neck. METHODS All patients treated with Tr-EVAR over a period of 10 years were identified retrospectively. Demographic, clinical and outcome data were collected, and survival analysis was performed. The time-to-event was analyzed using Kaplan-Meier curves for complication-free survival, reintervention-free survival, and overall survival. RESULTS During the study period, 36 patients ruptured, symptomatic or large AAAs having unfavorable necks and not fit for open repair underwent Tr-EVAR. Two patients died in the first 30 days postprocedure (5.6%). The overall survival at 1 year, 3 years and 5 years were 86%, 72% and 54% respectively with a mean overall survival of 74.0 months (SE 7.8, 95% confidence interval 58.7-89.3) which was comparable to chimney endovascular aneurysm repair (EVAR). The complication-free survival and reintervention-free survival at 1 year, 3 years, and 5 years were 75%, 61%, 42%, 78%, 64%, and 45%, respectively. CONCLUSIONS Tr-EVAR can be considered as an off-the-shelf solution for urgent cases not fit for open repair with unfavourable neck features for standard EVAR. Careful patient selection and planning have generated acceptable immediate, midterm and long-term results comparable to those presented by chimney EVAR in the literature.
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Affiliation(s)
- Sivaram Premnath
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
| | - Aurelien Hostalery
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Peter Bungay
- Department of Interventional Radiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Greta Saggu
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Timothy Rowlands
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Sanjay Singh
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Escobar GA, Oderich GS, Farber MA, de Souza LR, Quinones-Baldrich WJ, Patel HJ, Eliason JL, Upchurch GR, H Timaran C, Black JH, Ellozy SH, Woo EY, Fillinger MF, Singh MJ, Lee JT, C Jimenez J, Lall P, Gloviczki P, Kalra M, Duncan AA, Lyden SP, Tenorio ER. Results of the North American Complex Abdominal Aortic Debranching (NACAAD) Registry. Circulation 2022; 146:1149-1158. [PMID: 36148651 DOI: 10.1161/circulationaha.120.045894] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hybrid debranching repair of pararenal and thoracoabdominal aortic aneurysms was initially designed as a better alternative to standard open repair, addressing the limitations of endovascular repair involving the visceral aorta. We reviewed the collective outcomes of hybrid debranching repairs using extra-anatomic, open surgical debranching of the renal-mesenteric arteries, followed by endovascular aortic stenting. METHODS Data from patients who underwent hybrid repair in 14 North American institutions during 10 years were retrospectively reviewed. Society of Vascular Surgery scores were used to assess comorbidity risk. Early and late outcomes, including mortality, morbidity, reintervention, and patency were analyzed. RESULTS A total of 208 patients (118 male; mean age, 71±8 years old) were treated by hybrid repair with extraanatomic reconstruction of 657 renal and mesenteric arteries (mean 3.2 vessels/patient). Mean aneurysm diameter was 6.6±1.3 cm. Thoracoabdominal aortic aneurysms were identified in 163 (78%) patients and pararenal aneurysms in 45 (22%). A single-stage repair was performed in 92 (44%) patients. The iliac arteries were the most common source of inflow (n=132; 63%), and most (n=150; 72%) had 3 or more bypasses. There were 30 (14%) early deaths, ranging widely across sites (0%-21%). A Society of Vascular Surgery comorbidity score >15 was the primary predictor of early mortality (P<0.01), whereas mortality was 3% in a score ≤9. Early complications occurred in 140 (73%) patients and included respiratory complications in 45 patients (22%) and spinal cord ischemia in 22 (11%), of whom 10 (45%) fully recovered. At 5 years, survival was 61±5%, primary graft patency was 90±2%, and secondary patency was 93±2%. The most significant predictor of late mortality was renal insufficiency (P<0.0001). CONCLUSIONS Mortality after hybrid repair and visceral debranching is highly variable by center, but strongly affected by preoperative comorbidities and the centers' experience with the technique. With excellent graft patency at 5 years, the outcomes of hybrid repair done at centers of excellence and in carefully selected patients may be comparable (or better) than traditional open or even totally endovascular approaches. However, in patients already considered as high-risk for surgery, it may not offer better outcomes.
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Affiliation(s)
| | - Gustavo S Oderich
- University of Texas Health Science Center at Houston, Houston, TX (G.S.O., E.R.T.)
| | - Mark A Farber
- University of North Carolina Health Care, Chapel Hill, NC (M.A.F.)
| | - Leonardo R de Souza
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil (L.R.d.S.)
| | | | - Himanshu J Patel
- University of Michigan Cardiovascular Center, Ann Arbor, MI (H.J.P., J.L.E.)
| | - Jonathan L Eliason
- University of Michigan Cardiovascular Center, Ann Arbor, MI (H.J.P., J.L.E.)
| | | | | | - James H Black
- Johns Hopkins Bayview Medical Center, Baltimore, MD (J.H.B)
| | - Sharif H Ellozy
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY (S.H.E.)
| | | | | | - Michael J Singh
- University of Pittsburgh Medical Center, Pittsburgh, PA (M.J.S.)
| | - Jason T Lee
- Stanford University Medical Center, Stanford, CA (J.T.L.)
| | - Juan C Jimenez
- University of California, Los Angeles, CA (W.J.Q.-B., J.C.J.)
| | - Purandath Lall
- Cleveland Clinic Martin Health, Port St. Lucie, FL (P.L., M.K.)
| | | | - Manju Kalra
- Cleveland Clinic Martin Health, Port St. Lucie, FL (P.L., M.K.).,Mayo Clinic, Rochester, MN (P.G., M.K.)
| | - Audra A Duncan
- Schulich School of Medicine and Dentistry, Western University, London, Ontario; Canada (A.A.D.)
| | - Sean P Lyden
- Cleveland Clinic Foundation, Cleveland, OH (S.P.L.)
| | - Emanuel R Tenorio
- University of Texas Health Science Center at Houston, Houston, TX (G.S.O., E.R.T.)
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Comparison of Clinical Outcomes Following One versus Two Stage Hybrid Repair of Thoraco-Abdominal Aortic Aneurysms: A Comprehensive Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 61:396-406. [PMID: 33358102 DOI: 10.1016/j.ejvs.2020.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE For thoraco-abdominal aortic aneurysms (TAAA), it is unclear whether it is better to perform hybrid repair in one (single) or two stages (staged). This study aimed to compare the clinical outcomes of single vs. staged hybrid repair of TAAA. METHODS The Medline, Embase, and Cochrane Databases (1 January 1994 to 11 May 2020) were searched for studies on hybrid repair of TAAA. Cohort studies and case series reporting outcomes of single and staged hybrid repair of TAAA were eligible for inclusion. The Newcastle-Ottawa scale and an 18 item tool were used to assess the risk of bias. The primary outcome was 30 day mortality, and the secondary outcomes included post-operative complications, overall survival, and other mid term events. A random effects model was used to calculate pooled estimates. RESULTS A total of 37 studies was included in the meta-analysis. The quality assessment of the included studies suggested low or moderate risk of bias. The pooled estimates for aneurysm rupture and death during stage interval were 2% (95% CI 0%-4%, I2 = 0%) and 4% (95% CI 2%-7%, I2 = 0%), respectively. Single repair was associated with a significantly higher 30 day risk of death when compared with patients who completed staged procedures successfully (OR 2.64, 95% CI 1.36-5.12, I2 = 0%). Staged repair also had lower incidence of major adverse cardiac events (MACE) (single: 10%, 95% CI 5%-16%; staged: 2%, 95% CI 0%-5%) and intestinal complications (single: 15%, 95% CI 8%-25%; staged: 3%, 95% CI 1%-6%). For mid term outcomes, single and staged repair had comparable 12 month overall survival, aneurysm related mortality, rate of re-intervention, and graft patency. CONCLUSION Two stage hybrid repair may represent a better choice for patients with controlled risk of aneurysm rupture, because it can provide lower 30 day mortality risks, MACE, and intestinal complications, as well as comparable mid term outcomes. Randomised controlled trials are needed to ascertain the effect of repair staging in patients for elective TAAA.
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7
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Hybrid repair of thoracoabdominal aneurysm: An alternative strategy for preventing major complications in high risk patients. Int J Cardiol 2018; 271:31-35. [DOI: 10.1016/j.ijcard.2018.04.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/11/2018] [Accepted: 04/30/2018] [Indexed: 01/16/2023]
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Komarov RN, Vinokurov IA, Karavaykin PA, Abdulmutalibov IM, Belov YV. [Staged approach for hybrid thoracoabdominal aortic replacement]. Khirurgiia (Mosk) 2018:21-27. [PMID: 29460875 DOI: 10.17116/hirurgia2018221-27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To generalize our experience of step-by-step hybrid thoracoabdominal aortic replacement. MATERIAL AND METHODS Twenty-three patients were enrolled who underwent staged hybrid treatment of thoracoabdominal aortic aneurysm. There were 5 (21.7%) women and 18 (78.3%) men aged 61.4±8.3 years (37-74 years). The first stage was proximal debranching, the second - distal (abdominal) procedure and the third - stenting of the thoracoabdominal aorta. RESULTS There were no any complications after proximal debranching and aortic stenting. Abdominal debranching was followed by lethal outcome in 3 (13.0%) patients and early postoperative occlusion of the prosthesis brunch in 3 out of 87 cases. CONCLUSION Staged approach for hybrid surgical treatment is optimal solution, especially in high risk patients. In our opinion no necessity for cardiopulmonary bypass is the main advantage of this technique.
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Affiliation(s)
- R N Komarov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - I A Vinokurov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - P A Karavaykin
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - I M Abdulmutalibov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - Yu V Belov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
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Moreno Bermudez K, Arias Páez C, Bautista Vacca C. Abordaje híbrido de la disfunción aórtica: a propósito de 2 casos y revisión de la literatura. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Alonso Pérez M, Llaneza Coto JM, Del Castro Madrazo JA, Fernández Prendes C, González Gay M, Zanabili Al-Sibbai A. Debranching aortic surgery. J Thorac Dis 2017; 9:S465-S477. [PMID: 28616343 DOI: 10.21037/jtd.2017.03.87] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Conventional open surgery still remains as the gold standard of care for aortic arch and thoracoabdominal pathology. In centers of excellence, open repair of the arch has been performed with 5% immediate mortality and a low rate of complications; however overall mortality rates are around 15%, being up to 40% of all patients rejected for treatment due to their age or comorbidities. For thoracoabdominal aortic pathology, data reported from centers of excellence show immediate mortality rates from 5% to 19%, spinal cord ischemia from 2.7% to 13.2%, and renal failure needing dialysis from 4.6% to 5.6%. For these reasons, different alternatives that use endovascular techniques, including debranching procedures, have been developed. The reported results for hybrid debranching procedures are controversial and difficult to interpret because series are retrospective, heterogenic and including a small number of patients. Clearly, an important selection bias exists: debranching procedures are performed in elderly patients with more comorbidities and with thoracoabdominal aortic aneurysms that have more complex and extensive disease. Considering this fact, debranching procedures still remain a useful alternative: for aortic arch pathology debranching techniques can avoid or reduce the time of extracorporeal circulation (ECC) or cardiac arrest which may be beneficial in high-risk patients that otherwise would be rejected for treatment. And compared to pure endovascular techniques, they can be used in emergency cases with applicability in a wide range of anatomies. For thoracoabdominal aortic aneurysms, they are mainly useful when other lesser invasive endovascular options are not feasible due to anatomical limitations or when they are not available in cases where delaying the intervention is not an option.
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Affiliation(s)
- Manuel Alonso Pérez
- Vascular Surgery Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 598] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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12
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van de Graaf RA, Grüne F, Hoeks SE, ten Raa S, Stolker RJ, Verhagen HJM, van Lier F. One-Year Follow-Up After Hybrid Thoracoabdominal Aortic Repair. Vasc Endovascular Surg 2016; 51:23-27. [DOI: 10.1177/1538574416683755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Compared to open thoracoabdominal aortic aneurysm (TAAA) repair, hybrid repair is thought to be less invasive with better perioperative outcomes. Due to the extent of the operation and long recovery period, studying perioperative results may not be sufficient for evaluation of the true treatment effect. The aim of this study is to evaluate 1-year mortality and morbidity in patients with TAAA undergoing hybrid repair. Methods: In a retrospective cohort study, all medical records of patients undergoing hybrid repair for TAAA at the Erasmus University Medical Center between January 2007 and January 2015 were studied. Primary outcome measures were 30-day and 1-year mortality. Secondary outcome measures included major in-hospital postoperative complications. Results: A total of 15 patients were included. All-cause mortality was 33% (5 of the 15) at 30 days and 60% (9 of the 15) at 1 year. Aneurysm-related mortality was 33% (5 of the 15) and 53% (8 of the 15) at 30-day and 1-year follow-up, respectively, with colon ischemia being the most common cause of death. Major complication rate was high: myocardial infarction in 2 (13%) cases, acute kidney failure in 5 (33%) cases, bowel ischemia in 3 (20%) cases, and spinal cord ischemia in 1 (7%) case. Conclusion: The presumed less invasive nature of hybrid TAAA repair does not seem to result in lower complication rates. The high mortality rate at 30 days continues to rise dramatically thereafter, suggesting that 1-year mortality is a more useful clinical parameter to use in preoperative decision-making for this kind of repair.
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Affiliation(s)
- Rob A. van de Graaf
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Vascular surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank Grüne
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sanne E. Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Vascular surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sander ten Raa
- Department of Vascular surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hence J. M. Verhagen
- Department of Vascular surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- Both authors contributed equally as a senior author to this work
| | - Felix van Lier
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Both authors contributed equally as a senior author to this work
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Alonso Pérez M, Camblor Santervás L, González Gay M, Zanabili Al-Sibbai A, Valle González A, Llaneza Coto J. Cirugía abdominal híbrida para el tratamiento de los aneurismas toracoabdominales complejos. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Benrashid E, Wang H, Andersen ND, Keenan JE, McCann RL, Hughes GC. Complementary roles of open and hybrid approaches to thoracoabdominal aortic aneurysm repair. J Vasc Surg 2016; 64:1228-1238. [PMID: 27444368 DOI: 10.1016/j.jvs.2016.04.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Thoracoabdominal aortic aneurysm (TAAA) repair remains a significant challenge with considerable perioperative morbidity and mortality. A hybrid approach utilizing visceral debranching with endovascular aneurysm exclusion has been used to treat high-risk patients and therefore allow repair in more patients. Limited data exist regarding long-term outcomes with this procedure as well as comparison to conventional open repair. This study describes our institutional algorithmic approach to TAAA repair using both open and hybrid techniques. METHODS Hybrid and open TAAA repairs performed between July 2005 and August 2015 were identified from a prospectively maintained institutional aortic surgery database. Perioperative morbidity and mortality, freedom from reintervention, and long-term and aorta-specific survival were calculated and compared between the two groups. RESULTS During the study period, 165 consecutive TAAA repairs were performed, including 84 open repairs and 81 hybrid repairs. Patients in the hybrid repair group were significantly older, were more frequently female, and had a generally greater comorbid disease burden, including significantly more chronic kidney disease. Despite the older and sicker cohort, there was no difference in in-hospital mortality between the two groups (9.9% hybrid vs 7.1% open; P = .59). Major morbidity rates differed by procedure, with patients undergoing open repair having a significantly higher rate of postoperative stroke (9.5% open vs 0% hybrid; P = .017), whereas patients undergoing hybrid repair had a higher rate of new permanent dialysis (14.8% hybrid vs 3.6% open; P = .043). There was no difference between groups in the rate of postoperative permanent paraplegia/paresis (8.3% open vs 7.4% hybrid; P = .294). There was a significantly increased rate of reintervention in the hybrid repair group (12.3% hybrid vs 1.2% open, P = .004), with all hybrid reinterventions performed because of endoleak. One-year survival was similar between groups at 69% in hybrid repairs vs 77% in open repairs. Long-term survival was worse in the hybrid group (5-year survival, 32% hybrid vs 56% open), although late survival appeared to be influenced mainly by comorbid disease burden, given the similar long-term aorta-specific survival between groups. CONCLUSIONS Use of an algorithmic approach whereby higher risk patients with TAAA are treated by a hybrid approach and lower risk patients with conventional open repair yields satisfactory short- and long-term outcomes. The availability of multiple options for TAAA repair within a single center likely allows repair in more patients with consequent decrease in the risk of aorta-related death, at the expense of increased reinterventions for endoleak.
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Affiliation(s)
- Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hanghang Wang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Nicholas D Andersen
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jeffrey E Keenan
- Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Richard L McCann
- Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
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15
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Ljungman C, Wanhainen A, Kragsterman B, Nyman R, Ericksson LG, Eriksson MO. Propositions for Refinement of the Hybrid Surgical Technique for Treatment of Thoraco-Abdominal Aortic Aneurysm. Scand J Surg 2016; 97:174-7. [DOI: 10.1177/145749690809700221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traditional open repair of thoraco-abdominal aortic aneurysms Crawford type II-IV carries a high perioperative risk and mortality. The hybrid technique for combined surgical and endovascular treatment offers an interesting alternative with reduced risk of paraparesis and possibly a reduced mortality rate. Propositions for refinement of this approach are outlined based on a single centre experience.
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Affiliation(s)
- C. Ljungman
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Sweden
| | - A. Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Sweden
| | - B. Kragsterman
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Sweden
| | - R. Nyman
- Interventional Radiology Unit Department of Diagnostic Radiology, Uppsala University Hospital, Sweden
| | - L.-G. Ericksson
- Interventional Radiology Unit Department of Diagnostic Radiology, Uppsala University Hospital, Sweden
| | - M. O. Eriksson
- Interventional Radiology Unit Department of Diagnostic Radiology, Uppsala University Hospital, Sweden
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16
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Di Bartolomeo R, Murana G, Cefarelli M, Alfonsi J, Di Marco L, Buia F, Lovato L, Pacini D. Hybrid two-stage repair of thoracoabdominal aortic aneurysm. Multimed Man Cardiothorac Surg 2016; 2016:mmw008. [PMID: 27188444 DOI: 10.1093/mmcts/mmw008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/31/2016] [Indexed: 11/12/2022]
Abstract
Thoracoabdominal aortic aneurysm is a challenging disease that often requires an invasive surgical repair. Recently, a less invasive hybrid approach has been proposed to improve postoperative outcomes in high-risk patients. It consists of an open first stage where arterial visceral rerouting is obtained, using a vascular graft followed by a second stage where the remaining thoracoabdominal aorta is covered with a stent graft. Initial results using this approach seem promising. Here, we sought to describe the hybrid two-stage technique that is most frequently used in this extensive aortic pathology.
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Affiliation(s)
- Roberto Di Bartolomeo
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giacomo Murana
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Jacopo Alfonsi
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luca Di Marco
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesco Buia
- Department of Radiology, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luigi Lovato
- Department of Radiology, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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17
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A computational simulation of the effect of hybrid treatment for thoracoabdominal aortic aneurysm on the hemodynamics of abdominal aorta. Sci Rep 2016; 6:23801. [PMID: 27029949 PMCID: PMC4814838 DOI: 10.1038/srep23801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/15/2016] [Indexed: 02/05/2023] Open
Abstract
Hybrid visceral-renal debranching procedures with endovascular repair have been proposed as an appealing technique to treat conventional thoracoabdominal aortic aneurysm (TAAA). This approach, however, still remained controversial because of the non-physiological blood flow direction of its retrograde visceral revascularization (RVR) which is generally constructed from the aortic bifurcation or common iliac artery. The current study carried out the numerical simulation to investigate the effect of RVR on the hemodynamics of abdominal aorta. The results indicated that the inflow sites for the RVR have great impact on the hemodynamic performance. When RVR was from the distal aorta, the perfusion to visceral organs were adequate but the flow flux to the iliac artery significantly decreased and a complex disturbed flow field developed at the distal aorta, which endangered the aorta at high risk of aneurysm development. When RVR was from the right iliac artery, the abdominal aorta was not troubled with low WSS or disturbed flow, but the inadequate perfusion to the visceral organs reached up to 40% and low WSS and flow velocity predominated appeared at the right iliac artery and the grafts, which may result in the stenosis in grafts and aneurysm growth on the host iliac artery.
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18
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Belov YV, Komarov RN, Karavaykin PA. Cardiovascular surgeon’s role in hybrid aortic surgery (part 2). ACTA ACUST UNITED AC 2016. [DOI: 10.17116/kardio20169134-41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Evolución terapéutica y controversias actuales en la cirugía de los aneurismas toracoabdominales. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Quatromoni JG, Orlova K, Foley PJ. Advanced Endovascular Approaches in the Management of Challenging Proximal Aortic Neck Anatomy: Traditional Endografts and the Snorkel Technique. Semin Intervent Radiol 2015; 32:289-303. [PMID: 26327748 DOI: 10.1055/s-0035-1558825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Advances in endovascular technology, and access to this technology, have significantly changed the field of vascular surgery. Nowhere is this more apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which endovascular aneurysm repair (EVAR) has replaced the traditional open surgical approach in patients with suitable anatomy. However, approximately one-third of patients presenting with AAAs are deemed ineligible for standard EVAR because of anatomic constraints, the majority of which involve the proximal aneurysmal neck. To overcome these challenges, a bevy of endovascular approaches have been developed to either enhance stent graft fixation at the proximal neck or extend the proximal landing zone to allow adequate apposition to the aortic wall and thus aneurysm exclusion. This article is composed of two sections that together address new endovascular approaches for treating aortic aneurysms with difficult proximal neck anatomy. The first section will explore advancements in the traditional EVAR approach for hostile neck anatomy that maximize the use of the native proximal landing zone; the second section will discuss a technique that was developed to extend the native proximal landing zone and maintain perfusion to vital aortic branches using common, off-the-shelf components: the snorkel technique. While the techniques presented differ in terms of approach, the available clinical data, albeit limited, support the notion that they may both have roles in the treatment algorithm for patients with challenging proximal neck anatomy.
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Affiliation(s)
- Jon G Quatromoni
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ksenia Orlova
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Paul J Foley
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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21
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Dzsinich C, Vaszily M, Vallus G, Dzsinich M, Berek P, Barta L, Darabos G, Nyiri G, Teknős D. ["Debranching" -- a new surgical option for the aortic arch and thoracoabdominal aorta hybrid interventions]. Magy Seb 2014; 67:353-61. [PMID: 25500642 DOI: 10.1556/maseb.67.2014.6.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Endovascular techniques in vascular surgery are frequently applied to treat aortic diseases. These minimally invasive procedures changed aortic interventions remarkably. We have to be familiar with new terminology and methods. METHOD New and old surgical procedures gained new role in preparation of endograft implantations. Transforming anatomy of aortic branches - "debranching" - is aimed to create a sufficient fixation of the endografts at safe "landing zones". CONCLUSIONS Knowing the option of hybrid procedures is a fundamental requirement for the vascular surgeon. Equally important is to know the biomechanical characteristics of the available endografts, the possible complications during and after implantation and the treatment options. We have to be aware of the limitations of these new methods and the role of traditional open surgery in the new era. Our intention in this paper is to summarize methods of debranching.
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Affiliation(s)
- Csaba Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Miklós Vaszily
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gábor Vallus
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Máté Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Péter Berek
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - László Barta
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gábor Darabos
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gabriella Nyiri
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Dániel Teknős
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
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22
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Orr N, Minion D, Bobadilla JL. Thoracoabdominal aortic aneurysm repair: current endovascular perspectives. Vasc Health Risk Manag 2014; 10:493-505. [PMID: 25170271 PMCID: PMC4145733 DOI: 10.2147/vhrm.s46452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thoracoabdominal aneurysms account for roughly 3% of identified aneurysms annually in the United States. Advancements in endovascular techniques and devices have broadened their application to these complex surgical problems. This paper will focus on the current state of endovascular thoracoabdominal aneurysm repair, including specific considerations in patient selection, operative planning, and perioperative complications. Both total endovascular and hybrid options will be considered.
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Affiliation(s)
- Nathan Orr
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - David Minion
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Joseph L Bobadilla
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
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23
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Rosset E, Ben Ahmed S, Galvaing G, Favre JP, Sessa C, Lermusiaux P, Hassen-Khodja R, Coggia M, Haulon S, Rinckenbach S, Enon B, Feugier P, Steinmetz E, Becquemin JP. Editor's choice--hybrid treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms: a multicenter retrospective study. Eur J Vasc Endovasc Surg 2014; 47:470-8. [PMID: 24656593 DOI: 10.1016/j.ejvs.2014.02.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess the results of hybrid techniques for the treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms based on multicenter results and the various series regarding hybrid procedures reported in the literature. METHODS The results of 76 hybrid procedures performed in 19 French university hospital centers between November 2001 and October 2011 were collected. There were 50 men and 26 women, mean age 68.2 (35-86) years. All patients were considered at high risk (ASA≥3) for conventional surgery. Aneurysms involved the thoracic, abdominal, and thoracoabdominal aorta in five, 14, and 57 cases respectively. There were 11 emergent repairs. The revascularization of four visceral arteries was performed in 38 cases. Between one and three visceral arteries were revascularized in the other cases. Visceral artery debranching and stent graft deployment were performed in a one-stage procedure in 53 cases and in a two-stage procedure in 23 cases. RESULTS There were 26 (34.2%) postoperative deaths. Nine of the survivors developed paraplegia, of which one resolved completely. Bowel ischemia occurred in 13 cases (17.1%), and one patient was treated by a superior mesenteric artery bypass. Four patients required long-term hemodialysis. Postoperative computed tomography scan showed a type II endoleak in two patients. CONCLUSIONS Morbidity and mortality in this study were greater than previously reported. Candidates for hybrid aortic repair should be carefully selected.
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Wu IH, Chan CY, Liang PC, Huang SC, Chi NS, Wang SS. One-stage Hybrid Repair to Thoracoabdominal Aortic Aneurysm. Ann Vasc Surg 2014; 28:201-8. [DOI: 10.1016/j.avsg.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
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25
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Tshomba Y, Melissano G, Logaldo D, Rinaldi E, Bertoglio L, Civilini E, Psacharopulo D, Chiesa R. Clinical outcomes of hybrid repair for thoracoabdominal aortic aneurysms. Ann Cardiothorac Surg 2013; 1:293-303. [PMID: 23977511 DOI: 10.3978/j.issn.2225-319x.2012.07.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/31/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Thoracoabdominal aortic aneurysm (TAAA) hybrid repair consists of aortic visceral branch rerouting followed by TAAA endograft exclusion. This technique has been shown to represent a technically feasible strategy in selected patients. METHODS We analyzed 52 high-risk patients who underwent hybrid TAAA repair between 2001 and 2012 in our centre with a variety of visceral rerouting configurations and of commercially available thoracic endografts. Thirty-seven simultaneous (71.2%) and 15 staged procedures (21.8%) were performed with a four-vessel revascularization in 18 cases (34.6%), a three-vessel revascularization in 11 cases (21.2%) and a two-vessel revascularization in 23 cases (44.2%). RESULTS No intraoperative deaths were observed. We recorded a perioperative mortality rate of 13.5% (n=7), including deaths from multiorgan failure (n=2), myocardial infarction (n=2), coagulopathy (n=1), pancreatitis (n=1) and bowel infarction (n=1). Perioperative morbidity rate was 28.8% (n=15), including 2 cases of transient paraparesis and 1 case of permanent paraplegia. Renal failure (n=5), pancreatitis (n=3), respiratory failure (n=3) and dysphagia (n=1) were also observed. At median follow-up of 23.9 months procedure-related mortality rate was 9.6%: two patients died from visceral graft occlusion and three from aortic rupture. There were three endoleaks and one endograft migration, none of which resulted in death. Five patients (9.6%) died as a consequence of unrelated events. CONCLUSIONS Typical complications of conventional TAAA open surgery have not been eliminated by hybrid repair, and significant mortality and morbidity rates have been recorded. Fate of visceral bypasses and incidence of endoleak and other endograft-related complications needs to be carefully assessed. Hybrid TAAA repair should currently be limited to high-risk surgical patients with unfit anatomy for endovascular repair.
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Affiliation(s)
- Yamume Tshomba
- Department of Vascular Surgery, University Vita-Salute, IRCCS O. San Raffaele, Milan, Italy
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26
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Moulakakis KG, Mylonas SN, Antonopoulos CN, Liapis CD. Combined open and endovascular treatment of thoracoabdominal aortic pathologies: a systematic review and meta-analysis. Ann Cardiothorac Surg 2013; 1:267-76. [PMID: 23977508 DOI: 10.3978/j.issn.2225-319x.2012.08.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/03/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND A combined open-endovascular technique has emerged as an alternative treatment option for thoracoabdominal pathologies. However, reported experiences from various medical centers have been contradictory and heterogeneous. The aim of this study is to assess the mortality rate and various complication rates associated with this approach. METHODS An electronic health database search was performed on all articles published up to March of 2012 describing combined open-endovascular repair of thoracoabdominal pathologies. Studies were included in the meta-analysis if they had ≥10 patients and reported the basic outcome criteria. End points of the meta-analysis were defined as primary technical success, endoprosthesis related complications, 30-day/in-hospital mortality, symptoms of spinal cord ischemia (SCI) and irreversible paraplegia, permanent renal function impairment, and other major complications. RESULTS Fourteen studies were deemed eligible for this meta-analysis with a total of 528 patients (68.0% male, mean age 70.5 years). The mean follow-up period was 34.2 months. The pooled estimate for primary technical success and visceral graft patency was 95.4% and 96.5% respectively. An endoleak developed in 106 (21.1%) patients in whom both stages had been completed. The pooled rate for symptomatic SCI was 7.0% and for irreversible paraplegia 4.4%. The pooled proportion for permanent renal failure was 7.0% and for mesenteric ischemia 4.5%. Prolonged respiratory support and cardiac complications were observed in a pooled rate of 7.8% and 4.6% respectively. The meta-analysis for 30-day/in-hospital mortality revealed a pooled rate of 14.3%. CONCLUSIONS Although the hybrid technique for thoracoabdominal aortic pathology provides a less invasive approach, the technique is still associated with a considerable morbidity and mortality rates. High risk patients unfit to withstand open repair, are equally likely to suffer significant complications with the hybrid procedure. The choice of the optimal treatment strategy for thoracoabdominal pathologies should be carefully made on a patient to patient basis, assessing the clinical fitness and the anatomical suitability of each patient. The hybrid approach should be reserved for high volume centers with accumulated experience and high standards of perioperative management.
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Affiliation(s)
- Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece; ; The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia
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27
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Chung C, Malik R, Marin M, Faries P, Ellozy S. Staged hybrid open and endovascular exclusion of a symptomatic thoracoabdominal aortic aneurysm in a high-risk patient. Vascular 2013; 22:280-5. [PMID: 23929424 DOI: 10.1177/1708538113492515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thoracoabdominal aortic aneurysms have a higher prevalence in the elderly, who are often poor surgical candidates. These extensive aneurysms may be lethal if left untreated. Conventional open repair has proven to be a major task, involving cardiopulmonary bypass, aortic cross-clamping and expeditious repair of an inaccessible structure involving two body cavities. Endovascular repair has become a viable option to treat isolated descending thoracic aneurysms and infrarenal abdominal aortic aneurysms. However, endovascular techniques alone have been less applicable for treating complex aortic aneurysms, including those involving visceral vessels. Therefore, a hybrid open and endovascular approach with visceral debranching has become an increasingly favorable alternative for patients with these complex conditions. We report a case in which a staged hybrid approach was used for successful exclusion of an extensive thoracoabdominal aortic aneurysm in a symptomatic, high-risk patient who would not have been an appropriate candidate for open surgical repair.
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Affiliation(s)
- Christine Chung
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Rajesh Malik
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Michael Marin
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Peter Faries
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Sharif Ellozy
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Clinical outcomes of single versus staged hybrid repair for thoracoabdominal aortic aneurysm. J Vasc Surg 2013; 58:1192-200. [PMID: 23810260 DOI: 10.1016/j.jvs.2013.04.061] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated the outcomes of hybrid repair of thoracoabdominal aortic aneurysms and performed meta-analyses and meta-regressions to assess whether the number of stages during hybrid repair is associated with mortality. METHODS Review methods were according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The primary outcome was 30-day mortality. Secondary outcomes of procedural and clinical success were reported descriptively. Meta-analyses, meta-regressions, and logistic regressions were performed to estimate the odds ratio (OR) describing the association between the staging of the operation and in-hospital death. RESULTS We included 19 studies of 660 patients. Procedures were single-staged in 288 patients and staged in 372. Perioperative mortality ranged from 0% to 44.4%, and spinal cord ischemia ranged from 0% to 15.3%. After a mean follow-up of 26 months (range, 6-88.5 months), the overall mortality was 20.8%. The meta-regression of all studies' summary data (OR, 0.64; 95% confidence interval [CI], 0.19-2.16; P = .45; I(2) = 0.42) and a meta-regression where mortality rates in four studies were stratified by operative staging (OR, 0.57; 95% CI, 0.24-1.36; P = .19; I(2) = 0.38) supported a two-stage procedure but failed to reach statistical significance. Logistic regressions of individual patient data from a single center demonstrated evidence that a staged procedure was safer (adjusted OR, 0.04; 95% CI, 0.00-0.96; P < .05). CONCLUSIONS Hybrid repair of thoracoabdominal aortic aneurysms may reduce early morbidity and mortality even in a group considered high risk for open surgery but still carries risks of perioperative complications. This study suggested advantages to a staged procedure, but statistically significant evidence is lacking. Prospective data are still needed to optimize hybrid repair and best define its role.
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Shahverdyan R, Gawenda M, Brunkwall J. Five-year Patency Rates of Renal and Visceral Bypasses after Abdominal Debranching for Thoraco-abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2013; 45:648-56. [DOI: 10.1016/j.ejvs.2013.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 03/14/2013] [Indexed: 11/15/2022]
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Liu Z, Zhou M, Liu C, Qiao T, Huang D, Zhang M, Ran F, Wang W, Liu C. Hybrid procedures for thoracoabdominal aortic pathologies. Vascular 2013; 21:205-14. [PMID: 23518841 DOI: 10.1177/1708538113478772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report our three-year experience with the visceral hybrid procedure for patients with thoracoabdominal aortic aneurysms, dissections and Takayasu's arteritis. We also evaluate and discuss the outcomes of hybrid procedures. Hybrid procedures include debranching of the visceral or renal arteries followed by endovascular repair of the disease. The surgical strategy was designed individually to reduce trauma and minimize stent coverage area. A series of 11 patients (9 men, mean age 52 years) were treated between June 2008 and September 2011. The pathologies were aneurysmal disease (thoracoabdominal aortic aneurysms) (5, 45.5%), aortic dissection (thoracoabdominal aortic dissection) (4, 36.4%) or true/false aneurysm formation after Takayasu's arteritis (2, 18.2%). Simultaneous approach (9, 81.8%) and staged approach (2, 18.2%) were performed. The mean follow-up was 13.5 months (range 1–36). The technical success was 100%. Stent grafts were implanted in the entire or part of the thoracoabdominal aorta. The overall mortality rate was 9.1% (1/11) with no aneurysm-related death. The permanent paraplegia and bypass graft occlusion rate was 0%. The overall morbidity was 36.4% with two endoleaks (2/11, 18.2%). In conclusion, hybrid procedures can minimize surgical invasiveness in treatments of thoracoabdominal aortic pathologies, and it is a safe method with acceptable morbidity and mortality.
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Affiliation(s)
- Zhao Liu
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Min Zhou
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Chen Liu
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Tong Qiao
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Dian Huang
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Ming Zhang
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Feng Ran
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Wei Wang
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Changjian Liu
- Department of Vascular Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
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Lobato AC, Camacho-Lobato L. A New Technique to Enhance Endovascular Thoracoabdominal Aortic Aneurysm Therapy—The Sandwich Procedure. Semin Vasc Surg 2012; 25:153-60. [DOI: 10.1053/j.semvascsurg.2012.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Hybrid treatment of a thoracoabdominal aortic aneurysm in China: report of the first successful case. Surg Today 2012; 42:1219-24. [DOI: 10.1007/s00595-012-0164-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 09/26/2011] [Indexed: 11/27/2022]
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Lee JT, Greenberg JI, Dalman RL. Early experience with the snorkel technique for juxtarenal aneurysms. J Vasc Surg 2012; 55:935-46; discussion 945-6. [PMID: 22244859 DOI: 10.1016/j.jvs.2011.11.041] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA 94305, USA.
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Moulakakis KG, Mylonas SN, Avgerinos ED, Kakisis JD, Brunkwall J, Liapis CD. Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies. Circulation 2011; 124:2670-80. [DOI: 10.1161/circulationaha.111.041582] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Many authors using a hybrid debranching strategy for the treatment of thoracoabdominal pathologies have reported disappointing results and the initial enthusiasm for the technique has given way to criticism and ambiguity. The aim of the present meta-analysis study was to assess the safety and efficacy of the technique in patients with thoracoabdominal aortic aneurysms or other aortic pathologies.
Methods and Results—
A multiple electronic search was performed on all articles describing hybrid open endovascular repair. Separate meta-analyses were conducted for technical success, visceral graft patency, spinal cord ischemia symptoms, renal insufficiency, and other complications as well as 30-day/in-hospital mortality.
Nineteen publications with a total of 507 patients were analyzed. The pooled estimates for primary technical success and visceral graft patency were 96.2% (95% CI, 93.5%–98.2%) and 96.5% (95% CI, 95.2%–97.8%) respectively. A pooled rate of 7.5% (95% CI, 5.0%–11.0%) for overall spinal cord ischemia symptoms was observed; whereas for irreversible paraplegia the pooled rate was 4.5% (95% CI, 2.5%–7.0%). The pooled estimate for renal failure was 8.8% (95% CI, 3.9%–15.5%). The pooled 30-day/in-hospital mortality rate was 12.8% (95% CI, 8.6%–17.0%). During the mean follow-up period of 34.5 (95% CI, 31.5–37.5) months, a total of 119 endoleaks were identified in 111 patients (22.7%).
Conclusions—
The repair of thoracoabdominal pathologies by means of hybrid procedures in patients who are poor surgical candidates is still associated with significant morbidity and mortality rates. Future studies may substantiate whether the technique is amenable to amelioration and improvement.
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Affiliation(s)
- Konstantinos G. Moulakakis
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Spyridon N. Mylonas
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Efthimios D. Avgerinos
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - John D. Kakisis
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Jan Brunkwall
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Christos D. Liapis
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
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Jenkins MP, Haulon S, Greenberg RK, Forbes TL. Debate regarding the best surgical option for type IV thoracoabdominal aortic aneurysms. J Vasc Surg 2011; 54:258-67. [DOI: 10.1016/j.jvs.2011.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ham SW, Chong T, Moos J, Rowe VL, Cohen RG, Cunningham MJ, Wilcox A, Weaver FA. Arch and visceral/renal debranching combined with endovascular repair for thoracic and thoracoabdominal aortic aneurysms. J Vasc Surg 2011; 54:30-40; discussion 40-1. [DOI: 10.1016/j.jvs.2010.12.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/06/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
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37
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Jenkins M. Part One: Treatment of Type IV Thoracoabdominal Aneurysms – Hybrid Technique with Debranching is the Best Option. Eur J Vasc Endovasc Surg 2011; 42:1-4. [DOI: 10.1016/j.ejvs.2011.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA. Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 2011; 53:895-904; discussion 904-5. [PMID: 21211934 DOI: 10.1016/j.jvs.2010.10.068] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/29/2010] [Accepted: 10/09/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Kevin J Bruen
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla., USA
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Bakoyiannis CN, Economopoulos KP, Kafeza M, Papalambros E. Commentary: Higher paraplegia/paraparesis and technical success rates of concurrent hybrid procedures in the treatment of thoracoabdominal aortic aneurysms. J Endovasc Ther 2010; 17:609-11. [PMID: 20939717 DOI: 10.1583/10-3051c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Chris N Bakoyiannis
- First Department of Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
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40
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Patency and durability of presewn multiple branched graft for thoracoabdominal aortic aneurysm repair. J Vasc Surg 2010; 51:1367-72. [DOI: 10.1016/j.jvs.2010.01.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 01/13/2010] [Accepted: 01/13/2010] [Indexed: 11/17/2022]
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41
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Alonso Pérez M, Llaneza Coto J, Camblor Santervás L, García de la Torre A, Valle González A, Domínguez Folgado R, Gutiérrez Julián J. Experiencia preliminar con cirugía híbrida en el tratamiento de los aneurismas toracoabdominales. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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42
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Kabbani LS, Criado E, Upchurch GR, Patel HJ, Eliason JL, Rectenwald J, Berguer R. Hybrid Repair of Aortic Aneurysms Involving the Visceral and Renal Vessels. Ann Vasc Surg 2010; 24:219-24. [DOI: 10.1016/j.avsg.2009.08.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 07/21/2009] [Accepted: 08/18/2009] [Indexed: 11/17/2022]
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Younes HK, Davies MG, Bismuth J, Naoum JJ, Peden EK, Reardon MJ, Lumsden AB. Hybrid thoracic endovascular aortic repair: Pushing the envelope. J Vasc Surg 2010; 51:259-66. [PMID: 19954918 DOI: 10.1016/j.jvs.2009.09.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 09/16/2009] [Accepted: 09/19/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Houssam K Younes
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Tex 77030, USA
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44
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Hybrid repair of complex thoracoabdominal aortic aneurysms using applied endovascular strategies combined with visceral and renal revascularization. J Thorac Cardiovasc Surg 2009; 138:1331-8. [DOI: 10.1016/j.jtcvs.2009.03.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 12/03/2008] [Accepted: 03/21/2009] [Indexed: 11/18/2022]
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46
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Bakoyiannis C, Kalles V, Economopoulos K, Georgopoulos S, Tsigris C, Papalambros E. Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms:. J Endovasc Ther 2009; 16:443-50. [DOI: 10.1583/1545-1550-16.4.443] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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von Meyenfeldt E, Schnater J, Reekers J, Balm R. An Emergency Visceral Hybrid Procedure for Ruptured Thoraco-Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2009; 38:162-8. [DOI: 10.1016/j.ejvs.2009.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 03/07/2009] [Indexed: 11/25/2022]
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48
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Sadeghi-Azandaryani M, Treitl M, Steckmeier B, Heyn J. Visceral embolus protection by catheters with balloon-inflatable tips during hybrid repair of thoracoabdominal aortic aneurysm. J Vasc Surg 2009; 50:442-6. [PMID: 19631885 DOI: 10.1016/j.jvs.2008.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 10/20/2022]
Abstract
Thoracoabdominal aortic aneurysms (TAAA) are associated with high rupture rates and poor outcome in patients who do not have surgical repair. Endovascular and hybrid techniques have gained increasing acceptance for the treatment of TAAA in patients with multiple comorbidities and an increased anesthetic risk. One of the complications of endovascular repair in TAAA is procedurally related embolism to visceral vessels. Visceral embolism causes bowel ischemia and is a potentially lethal complication. This report illustrates the intermittent use of catheters with balloon-inflatable tips as visceral embolus protection systems. These catheters are easy to apply and demonstrated perfect prevention of visceral embolization. To date, 10 patients have undergone operations at our clinic using this protection system, and no embolic complications were observed at the visceral vessels. Therefore, catheters with balloon-inflatable tips for visceral embolous protection should be considered in patients undergoing a two-stage hybrid TAAA repair to avoid embolus-associated morbidity and mortality.
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Is Hybrid Procedure the Best Treatment Option for Thoraco-Abdominal Aortic Aneurysm? Eur J Vasc Endovasc Surg 2009; 38:26-34. [DOI: 10.1016/j.ejvs.2009.03.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 03/24/2009] [Indexed: 11/21/2022]
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50
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Quinones-Baldrich W, Jimenez JC, DeRubertis B, Moore WS. Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience. J Vasc Surg 2009; 49:1125-34. [DOI: 10.1016/j.jvs.2008.12.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 11/17/2008] [Accepted: 12/02/2008] [Indexed: 11/27/2022]
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