TY - JOUR
T1 - Hybrid Debranching With Endovascular Repair for Thoracoabdominal Aneurysms
T2 - A Comparison With Open Repair
AU - Patel, Himanshu J.
AU - Upchurch, Gilbert R.
AU - Eliason, Jonathan L.
AU - Criado, Enrique
AU - Rectenwald, John
AU - Williams, David M.
AU - Deeb, G. Michael
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2010/5
Y1 - 2010/5
N2 - Background: Hybrid visceral-renal debranching procedures with endovascular repair have recently been proposed as a less invasive alternative to conventional thoracoabdominal aortic aneurysm (TAAA) surgery. This study provides a concurrent assessment of hybrid and open TAAA repair. Methods: One hundred two consecutive patients (mean age, 63.0 years) underwent open (73) or hybrid (29) Crawford type 1 (19), 2 (50), or 3 (33) TAAA repair from 2000 to 2009. Hybrid debranching procedures were selected for patients considered poor operative risk for standard TAAA repair (27) or for patient preference (2). The TAAAs were fusiform atherosclerotic (68), dissection (30), or pseudoaneurysm (4). Fifty-seven patients (55.9%) had previously undergone aortic repair. Outcomes were analyzed with 100% follow-up (mean, 30.5 months). Results: Operative procedures were urgent or emergent in 16 (15.6%). Early mortality occurred in 13 (12.7%), and was independently predicted by use of hypothermic circulatory arrest (p = 0.005). Early morbidity included permanent paraplegia (12), stroke (1), need for dialysis (22), or tracheostomy (7). Independent correlates of a composite outcome comprised of early mortality and these early morbidities included an urgent-emergent presentation (p = 0.002) or open TAAA repair (p = 0.021). Kaplan-Meier survival was similar between open and hybrid TAAA groups (p = 0.88). Late mortality was independently predicted by the presence of diabetes (p = 0.052) or the need for dialysis at the time of TAAA repair (p < 0.001). Conclusions: Hybrid debranching procedures may reduce early morbidity and yield similar late survival, even in a group considered high risk for open surgery. These data support the increasing utilization of a hybrid debranching and endovascular approach for patients requiring thoracoabdominal aneurysmectomy.
AB - Background: Hybrid visceral-renal debranching procedures with endovascular repair have recently been proposed as a less invasive alternative to conventional thoracoabdominal aortic aneurysm (TAAA) surgery. This study provides a concurrent assessment of hybrid and open TAAA repair. Methods: One hundred two consecutive patients (mean age, 63.0 years) underwent open (73) or hybrid (29) Crawford type 1 (19), 2 (50), or 3 (33) TAAA repair from 2000 to 2009. Hybrid debranching procedures were selected for patients considered poor operative risk for standard TAAA repair (27) or for patient preference (2). The TAAAs were fusiform atherosclerotic (68), dissection (30), or pseudoaneurysm (4). Fifty-seven patients (55.9%) had previously undergone aortic repair. Outcomes were analyzed with 100% follow-up (mean, 30.5 months). Results: Operative procedures were urgent or emergent in 16 (15.6%). Early mortality occurred in 13 (12.7%), and was independently predicted by use of hypothermic circulatory arrest (p = 0.005). Early morbidity included permanent paraplegia (12), stroke (1), need for dialysis (22), or tracheostomy (7). Independent correlates of a composite outcome comprised of early mortality and these early morbidities included an urgent-emergent presentation (p = 0.002) or open TAAA repair (p = 0.021). Kaplan-Meier survival was similar between open and hybrid TAAA groups (p = 0.88). Late mortality was independently predicted by the presence of diabetes (p = 0.052) or the need for dialysis at the time of TAAA repair (p < 0.001). Conclusions: Hybrid debranching procedures may reduce early morbidity and yield similar late survival, even in a group considered high risk for open surgery. These data support the increasing utilization of a hybrid debranching and endovascular approach for patients requiring thoracoabdominal aneurysmectomy.
UR - http://www.scopus.com/inward/record.url?scp=77953029617&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77953029617&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2010.01.062
DO - 10.1016/j.athoracsur.2010.01.062
M3 - Article
C2 - 20417763
AN - SCOPUS:77953029617
SN - 0003-4975
VL - 89
SP - 1475
EP - 1481
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -