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Hybrid Repair of Thoracoabdominal Aortic Aneurysm with Rerouting of Visceral Arteries

  • Luca ApruzziEmail author
  • Vincenzo Ardita
  • Andrea Melloni
  • Yamume Tshomba
  • Roberto Chiesa
Chapter

Abstract

Despite the surgical technical evolution of open repair for thoracoabdominal aortic aneurysms (TAAA), this formidable surgical challenge is still associated with significant mortality and morbidity. In some high-risk patients, hybrid TAAA repair may allow a less-invasive approach. Usually a revascularization of visceral and renal arteries, via midline laparotomy, in a retrograde fashion from common iliac arteries is performed, and then the aneurysm is excluded with aortic endografting. This technique has the advantage of avoiding a two-cavity exposure, thoracic and suprarenal aortic cross-clamping and circulatory support, theoretically reducing visceral and spinal cord ischemia time.

Despite a less-invasive approach, the technique still represents major surgery, and the results are variable among different centers. In larger studies, the 30-day mortality rate is reported between 8.6% and 15%, and perioperative 30-day morbidity such as spinal cord ischemia, renal failure, and mesenteric ischemia is reported to be around 9%, 15%, and 8%, respectively.

A staged approach to visceral vessels debranching and aortic endograft appears to yield better results. Hybrid TAAA repair is a good option for elderly and high-risk patients who are unfit for conventional open repair and when full endovascular repair is not feasible.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luca Apruzzi
    • 1
    Email author
  • Vincenzo Ardita
    • 1
  • Andrea Melloni
    • 1
  • Yamume Tshomba
    • 2
    • 3
  • Roberto Chiesa
    • 4
  1. 1.Scientific Institute H. San Raffaele, Vita-Salute University School of MedicineMilanItaly
  2. 2.Unit of Vascular SurgeryFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
  3. 3.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly
  4. 4.Unit of Vascular SurgerySan Raffaele Scientific Institute, Vita-Salute UniversityMilanItaly

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