Aortic hybrid repair should be performed whenever possible

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Results of aortic hybrid repair procedures performed in 19 centres in France were presented by G Galvaing, CHU Clermont-Ferrand, AURC, France, at the 2010 European Society for Vascular Surgery (ESVS) annual meeting in Amsterdam, The Netherlands.

Hybrid techniques for thoraco-abdominal aortic lesions involve the combination of stent grafts and surgical debranching of the visceral arteries, Galvaing said. “Until now few reports have been published on that topic.”

 

Results were collected of 70 hybrid procedures carried out between November 2001 and January 2010 among 47 men and 23 women, mean age 68 years (41 to 86). The patients were considered at high risk for conventional surgery. Aneurysms were degenerative in 61 cases and secondary to dissection in nine. Aneurysms involved five thoracic, 11 abdominal, and 54 thoraco-abdominal aortic aneurysms. There were nine emergent repairs. The revascularisation of four visceral arteries was performed in 35 cases. In the other patients between one and three visceral arteries were revascularised. Visceral arteries debranching and stent graft deployment were performed as a one-stage procedure in 49 cases and a two-stage procedure in 21 cases. Four patients died following visceral artery debranching before the aneurysm exclusion procedure could be performed. The median time between the two stages was 59 days.

 

There were twenty five (35, 7%) postoperative deaths. Nine of the survivors developed paraplegia of which one was regressive. Bowel ischaemia was treated by superior mesenteric artery bypass graft in one patient. Renal failure necessitated definitive haemodialysis in four patients. In the patients who underwent two stage procedures no death was observed following stent graft deployment. Post-operative CT scan showed type I endoleak in three patients. Mean follow-up was 20 months (2–54). One patient who had type I endoleak died of rupture at three months.

 

In conclusion, Galvaing said, morbi-mortality in the multicentric retrospective study of using hybrid techniques for thoraco-abdominal aortic lesions was greater than previously reported. “Candidates for aortic hybrid repair should be carefully selected. Two-stage procedures seem preferable whenever feasible,” he said.

 

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