Hybrid treatment of multiple aortic aneurysms by combined conventional surgery and endovascular aortic repair

Benefit of minimally invasive treatment of concomitant multiple aortic aneurysms, atrial septal defect and colon cancer

Minimally invasive treatment of cardiovascular disease might decrease the risk of morbidity and mortality for high-risk patients. We describe a patient with concomitant large thoracic and abdominal aortic aneurysms, atrial septal defect (ASD) with heart failure and colon cancer with bleeding. We applied minimally invasive, transcatheter closure of the ASD and a hybrid approach to treat two aortic aneurysms, followed by colectomy. The postoperative course was uneventful with no complications. Minimal invasive treatment for cardiovascular diseases allowed safe and early treatment of malignancy in an elderly, high-risk patient.

Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms

PURPOSE

To minimize surgical invasiveness for extensive aortic aneurysms and expand the indications for thoracic endovascular aortic repair (TEVAR), we evaluated outcomes of hybrid procedures combining conventional surgical aortic repair and TEVAR for thoracic aortic aneurysms.

METHODS

The following hybrid procedures were performed: second-stage TEVAR after total aortic arch replacement using the elephant trunk as the landing zone in 17 patients; and for multiple aortic aneurysms, vascular graft replacement and TEVAR in 13 patients, vascular graft replacement and TEVAR with bypass in 2 patients, and TEVAR with bypass in 23 patients.

RESULTS

There were three (5.3%) hospital deaths, from serious complications including stroke, paraplegia, paraparesis, and aspiration pneumonia; and eight late deaths. There was only one aneurysm-related death, of a patient who underwent emergency surgery for an esophageal fistula resulting from enlargement of a residual false lumen of a thoracoabdominal aorta after second-stage TEVAR.

CONCLUSION

Hybrid procedures minimize surgical invasiveness in thoracic aortic aneurysm repair, but further evaluation of a larger number of patients is necessary.

Long-term results of second-stage thoracic endovascular aortic repair following total aortic arch replacement

PURPOSE

We investigated the surgical results of secondary thoracic endovascular aneurysm repair (TEVAR) using the elephant trunk graft after total aortic arch replacement (TAR) for extensive thoracic aortic lesions.

METHODS

The subjects comprised 16 patients who underwent TEVAR as a staged procedure following TAR at our institution between 1997 and 2007. Long-term results were retrospectively surveyed (mean observation period 68.4 months). We performed TEVAR with the elephant trunk graft as a proximal landing zone for the descending thoracic repair, the mean duration between TAR and TEVAR was 4.7 weeks for the staged operations and 18.3 months for the nonstaged operations.

RESULTS

Early results were good in all cases, with no deaths and no noteworthy complications. For the seven patients without dissection, long-term results were also good. Among the nine patients with dissection, the false lumen in the thoracoabdominal area enlarged in three during follow-up. We performed thoracoabdominal repair in two, but one died of an aneurysm-esophageal fistula. There was only one long-term aneurysm-related death.

CONCLUSION

Second-stage TEVAR using the elephant trunk graft after TAR allows less invasive surgery for extensive aortic lesions and achieves good long-term results. However, enlargement of the false lumen was a long-term concern in patients with aortic dissection, and careful follow-up is essential.