The Visceral Hybrid Repair of Thoraco-abdominal Aortic Aneurysms – A Collaborative Approach

Abstract 

Objective

To report the collaborative data of 3 major European Vascular Units using the ‘visceral hybrid’ procedure for thoraco-abdominal aortic aneurysms and dissections.

Methods

A consecutive series of 107 urgent and elective high-risk patients were included in a prospectively collected database.

Results

All stents involved the entire thoracic and abdominal aorta with left subclavian coverage in 19 and revascularisation in 12. The distal landing zone was in the infra-renal aorta in 75% and in the iliac artery in 25%. The 30-day mortality rate was 16/107 (14.95%). 13/107 (12.1%) of the patients suffered spinal cord ischaemia which was complete and permanent in 9/12 (8.4%). 4 patients (3.7%) required long term dialysis and a segment of gut infarction requiring resection occurred in 3 (2.8%). Most patients had visceral bypass grafting and aortic stent-grafting performed in one stage. In 18 patients the stenting was performed later. Three of these patients ruptured before the stenting procedure was undertaken.

Conclusion

These early results of visceral hybrid repair for high-risk patients with complex thoraco-abdominal aortic aneurysms are encouraging, in a group of patients in whom fenestrated/branched stent-grafting is not an option and open surgery hazardous.

Keywords: Visceral hybrid thoraco-abdominal, aortic aneurysm