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Chisci E, Pigozzi C, Alberti A, Masciello F, Troisi N, Turini F, Michelagnoli S. Staged in situ aorto-iliac hybrid technique: an original technique to treat complex juxtarenal and iliac aneurysms. INT ANGIOL 2020; 39:517-524. [PMID: 33140625 DOI: 10.23736/s0392-9590.20.04457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To report a novel staged hybrid technique to treat complex juxtarenal abdominal aortic aneurysm (JAAA) associated with at least one iliac artery aneurysm (IA) with no adequate distal fixation zone. METHODS The novel technique herein described has two main "staged" steps. The first step consists in creating an adequate distal fixation zone by endovascular means; after hypogastric embolization an iliac stent-graft has placed from 5 mm above the aortic bifurcation to the external iliac artery. The second step is the surgical resection of the JAAA and graft placement sutured distally to the stent-graft which was always performed the day after. RESULTS The five cases included (mean age 74 years), were rejected for fenestrated or branched endovascular aortic repair or iliac branch devices. Four tube grafts and one aorto-bi-iliac graft were sutured to one stent-graft (N.=3), two stent-grafts in iliac kissing configuration (N.=1) and to a main body of a bifurcated stent-graft (N.=1). Mean follow-up duration was 14 (4-27) months with no mortality. Technical success was obtained in all cases (2 suprarenal clamping). Postoperative complications included two pleural effusions, two transient gluteal intermittent claudications, and one renal failure. CONCLUSIONS The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.
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Affiliation(s)
- Emiliano Chisci
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy -
| | - Clara Pigozzi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Aldo Alberti
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Fabrizio Masciello
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Nicola Troisi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Filippo Turini
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Stefano Michelagnoli
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
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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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Choong AMTL, Clough RE, Bicknell C, Warren O, Hamady M, Jenkins MP, Cheshire NJW. Recent advances in thoraco-abdominal aortic aneurysm repair. Surgeon 2010; 8:28-38. [PMID: 20222400 DOI: 10.1016/j.surge.2009.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thoraco-abdominal aortic aneurysm repair remains a formidable challenge to vascular surgeons. The traditional repair of thoraco-laparotomy with aortic cross-clamping is associated with a high morbidity and mortality despite significant advances in perioperative critical care, anaesthetic and surgical techniques. The advent of the endovascular revolution has shown a marked paradigm in the approach to all aneurysm repairs. As a logical progression from the open repair, the St Mary's visceral hybrid repair combines traditional open techniques (retrograde visceral and renal revascularisation via mid-line laparotomy) with endovascular stent grafting, thereby avoiding the need for thoracotomy and aortic cross-clamping. In specialist centres, the results have been encouraging and easily comparable to the open repair. The technique has been used in several centres around the world and represents a robust, transferrable method of repairing thoraco-abdominal aortic aneurysms. Stent-grafting technologies have reached a point of sophistication that wholly endovascular methods of repairing thoraco-abdominal aortic aneurysms are being performed in several centres around the world. Although these stent grafts have to be customised to the individual patient and are only suitable for certain types of aneurysmal anatomies, they represent the future of thoraco-abdominal aortic aneurysm repair. We review the history of thoraco-abdominal aortic aneurysm repair, the exciting advances in their treatment and discuss our approach to the management of thoraco-abdominal aortic aneurysms in the 21st century.
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Affiliation(s)
- A M T L Choong
- Department of Biosurgery and Surgical Technology, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College London, UK.
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Combined Open and Endovascular Treatment of Thoracoabdominal Aneurysms and Secondary Expanding Aortic Dissections: Early and Mid-Term Results From a Single-Center Series. Ann Vasc Surg 2010; 24:167-77. [DOI: 10.1016/j.avsg.2009.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 09/22/2009] [Accepted: 10/07/2009] [Indexed: 11/23/2022]
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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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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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van de Mortel RH, Vahl AC, Balm R, Buth J, Hamming JF, Schurink GW, de Vries JPP. Collective Experience with Hybrid Procedures for Suprarenal and Thoracoabdominal Aneurysms. Vascular 2008; 16:140-6. [DOI: 10.2310/6670.2008.00017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Not every patient is fit for open thoracoabdominal aortic aneurysm (TAAA) repair, nor is every TAAA or juxtarenal abdominal aortic aneurysm suitable for branched or fenestrated endovascular exclusion. The hybrid procedure consists of debranching of the renal and visceral arteries followed by endovascular exclusion of the aneurysm and might be an alternative in these patients. Between May 2004 and March 2006, 16 patients were treated with a hybrid procedure. The indications were recurrent suprarenal or thoracoabdominal aneurysms after previous abdominal and/or thoracic aortic surgery ( n = 8), type I to III TAAAs ( n = 3), proximal type I endoleak after endovascular repair ( n = 2), penetrating ulcer of the juxtarenal aorta ( n = 1), visceral patch aneurysm after type IV open repair ( n = 1), and primary suprarenal aneurysm ( n = 1). Eight (50%) of 16 patients were judged to be unfit for open TAAA repair. The hospital mortality rate was 31% (5 of 16). Four of five deceased patients were unfit for thoracophrenic laparotomy. Two patients died from cardiac complications and three from visceral ischemia. No spinal cord ischemia was detected, and temporary renal failure occurred in four patients (25%). The mean follow-up was 13 months (range 6–28 months). During follow-up, no additional grafts occluded and no patients died. Hybrid procedures are technically feasible but have substantial mortality (31%), especially in patients unfit for open repair (80%). They might be indicated when urgent TAAA surgery is required or when vascular anatomy is unfavorable for fenestrated endografts in patients with extensive previous open aortic surgery.
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Affiliation(s)
- Rob H.W. van de Mortel
- *Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; †Onze Lieve Vrouwe Gasthuis, Amsterdam; ‡Academic Medical Centre, Amsterdam; §Catharina-Hospital, Eindhoven; ‖Leids University Medical Centre, Leiden; and #Maastrichts University Medical Centre, the Netherlands
| | - Anco C. Vahl
- *Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; †Onze Lieve Vrouwe Gasthuis, Amsterdam; ‡Academic Medical Centre, Amsterdam; §Catharina-Hospital, Eindhoven; ‖Leids University Medical Centre, Leiden; and #Maastrichts University Medical Centre, the Netherlands
| | - Ron Balm
- *Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; †Onze Lieve Vrouwe Gasthuis, Amsterdam; ‡Academic Medical Centre, Amsterdam; §Catharina-Hospital, Eindhoven; ‖Leids University Medical Centre, Leiden; and #Maastrichts University Medical Centre, the Netherlands
| | - Jaap Buth
- *Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; †Onze Lieve Vrouwe Gasthuis, Amsterdam; ‡Academic Medical Centre, Amsterdam; §Catharina-Hospital, Eindhoven; ‖Leids University Medical Centre, Leiden; and #Maastrichts University Medical Centre, the Netherlands
| | - Jaap F. Hamming
- *Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; †Onze Lieve Vrouwe Gasthuis, Amsterdam; ‡Academic Medical Centre, Amsterdam; §Catharina-Hospital, Eindhoven; ‖Leids University Medical Centre, Leiden; and #Maastrichts University Medical Centre, the Netherlands
| | - Geert W.H. Schurink
- *Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; †Onze Lieve Vrouwe Gasthuis, Amsterdam; ‡Academic Medical Centre, Amsterdam; §Catharina-Hospital, Eindhoven; ‖Leids University Medical Centre, Leiden; and #Maastrichts University Medical Centre, the Netherlands
| | - Jean-Paul P.M. de Vries
- *Department of Vascular Surgery, St Antonius Hospital, Nieuwegein; †Onze Lieve Vrouwe Gasthuis, Amsterdam; ‡Academic Medical Centre, Amsterdam; §Catharina-Hospital, Eindhoven; ‖Leids University Medical Centre, Leiden; and #Maastrichts University Medical Centre, the Netherlands
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Hybridverfahren zur Therapie thorakoabdomineller Aortenaneurysmen (TAAA). GEFASSCHIRURGIE 2007. [DOI: 10.1007/s00772-007-0553-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chao AB, Major K, Hood DB, Patel KR, Rowe VL, Weaver FA. Preliminary retrograde visceral artery reconstruction for thoracoabdominal aortic aneurysms. Ann Vasc Surg 2007; 21:123-8. [PMID: 17349349 DOI: 10.1016/j.avsg.2006.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 10/13/2006] [Accepted: 10/19/2006] [Indexed: 10/21/2022]
Abstract
The recent availability of thoracic endografts has expanded the options for treatment of thoracoabdominal aortic pathology. However, disease that involves the visceral aortic segment presents a special challenge due to the need to preserve mesenteric perfusion. We present three patients in whom preliminary retrograde visceral artery reconstruction was used as an adjunct prior to endovascular repair.
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Affiliation(s)
- Alexander B Chao
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Gawenda M, Aleksic M, Heckenkamp J, Reichert V, Gossmann A, Brunkwall J. Hybrid-procedures for the Treatment of Thoracoabdominal Aortic Aneurysms and Dissections. Eur J Vasc Endovasc Surg 2007; 33:71-7. [PMID: 17056286 DOI: 10.1016/j.ejvs.2006.09.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 09/04/2006] [Indexed: 11/23/2022]
Abstract
AIM The conventional open repair of thoracoabdominal aneurysms and dissections remains complex and demanding and is associated with significant morbidity and mortality. We present our experience of hybrid open and endovascular treatment of thoracoabdominal aneurysms and dissections. METHODS Within an experience of 226 aortic stent-grafts between 1998 and April 2006, 6 of the patients (median age 60 years, range 35 to 68 years) with thoracoabdominal aneurysms (Crawford type I, II, III, and V) were treated with a combined endovascular and open surgical approach. Five men and one woman, with median aneurysm diameter of 75 mm (range 70-100 mm), received revascularization of the renal arteries, the superior mesenteric artery, and the coeliac trunk accomplished via transperitoneal bypass grafting. Aneurysmal exclusion was then performed by stent-graft deployment. RESULTS The entire procedure was technically successful in all patients. The patients were discharged a median of 9 days after the operation, while the postoperative studies revealed the patency of the vessels and no evidence of type I endoleak or secondary rupture of the aneurysm. During follow up (1 to 22 months) spiral-CT scanning revealed distinct shrinkage of the aneurysm, no graft migration or endoleak and patency of all revascularised vessels, except one renal artery in two patients. No patient experienced any temporary or permanent neurological deficit, and no dialysis was necessary. CONCLUSION The combined endovascular and open surgical approach is feasible, without cross clamping of the aorta and with minimized ischemia time for renal and visceral arteries, and seems to be an appropriate strategy for patients with a thoraco-abdominal aortic aneurysm or dissection.
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Affiliation(s)
- M Gawenda
- Division of Vascular Surgery, Medical Centre, University of Cologne, Cologne, Germany.
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