Skip to main content
SpringerLink
Log in
Book cover

Thoraco-Abdominal Aorta pp 451–467Cite as

Hybrid Procedures forThoraco-Abdominal Aortic Aneurysm

The San Raffaele Experience

  • Chapter

  • 1918 Accesses

Abstract

Thoraco-abdominal aortic aneurysm (TAAA) hybrid repair consists of rerouting of abdominal aortic visceral branches followed by TAAA endograft exclusion. In this chapter we report our single-center experience of 34 patients (28 males, median age 68.2 years, range 23 to 83 years) who underwent hybrid TAAA repair (13 type I, 4 type II, 7 type III, 3 type IV — Crawford classification — and 7 aneurysms of the visceral aortic patch) between 2001 and 2009. Patients’ data were prospectively collected in a computerized database. All patients were excluded from standard open surgery because of increased surgical risk and/or local technical concerns. Hybrid TAAA repair has been technically feasible in all cases undergoing TAAA exclusion, with a variety of operative strategies and materials. Typical complications of standard open surgery have not been eliminated by hybrid TAAA repair and there are still significant mortality and morbidity, and new threatening mid-term procedure-related complications have been reported. Larger series of hybrid TAAA repair with clear inclusion criteria and long-term follow-up are needed to establish a standardized operative technique and to make any statistically meaningful comparisons with standard open repair. Based on our experience with high-risk patients, hybrid TAAA repair should currently be limited as an alternative to simple observation in patients unfit for standard open repair.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Crawford ES, Snyder DM, Cho GC, Roehm JO. Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries. Ann Surg 1978; 188:404–422

    Article  PubMed  CAS  Google Scholar 

  2. Coselli JS. The use of left heart bypass in the repair of thoracoabdominal aortic aneurysms: current techniques and results. Semin Thorac Cardiovasc Surg 2003;15:326–332

    Article  PubMed  Google Scholar 

  3. Coselli JS, Conklin SA, LeMaire LD. Thoracoabdominal aortic aneurysm repair: review and update of current strategies. Ann Thorac Surg 2002;74:S1881–S1844

    Article  PubMed  Google Scholar 

  4. Schepens M, Dossche K, Morshuis W et al. Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm repairs. Eur J Cardiothorac Surg 2004;25:701–707

    Article  PubMed  Google Scholar 

  5. Coselli JS, LeMaire SA. Left heart bypass reduces paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 1999;67:1931–1934

    Article  PubMed  CAS  Google Scholar 

  6. Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg 2007;83:S862–S864

    Article  PubMed  Google Scholar 

  7. Engle J, Safi HJ, Miller CC III et al. The impact of diaphragm management on prolonged ventilator support after thoracoabdominal aortic repair. J Vasc Surg 1999;29:150–156

    Article  PubMed  CAS  Google Scholar 

  8. Cambria RP, Clouse WD, Davison JK et al. Thoracoabdominal aneurysm repair: results with 337 operations performed over a 15-year interval. Ann Surg 2002;236:471–479

    Article  PubMed  Google Scholar 

  9. Coselli JS, LeMaire SA, Köksoy C et al. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg 2002;35:631–639

    Article  PubMed  Google Scholar 

  10. Greenberg RK, Lytle B. Endovascular repair of thoracoabdominal aneurysms. Circulation 2008; 117:2288–2296

    Article  PubMed  Google Scholar 

  11. Chuter TA, Rapp JH, Hiramoto JS et al. Endovascular treatment of thoracoabdominal aortic aneurysms. J Vasc Surg 2008;47:6–16

    Article  PubMed  Google Scholar 

  12. Dardik A, Perler BA, Roseborough GS and Williams GM. Aneurysmal expansion of the visceral patch after thoracoabdominal aortic replacement: an argument for limiting patch size? J Vasc Surg 2001; 34:405–409

    Article  PubMed  CAS  Google Scholar 

  13. Chiesa R, Melissano G, Civilini E et al. Two-stage combined endovascular and surgical approach for recurrent thoracoabdominal aortic aneurysm. J Endovasc Ther 2004;11:330–333

    Article  PubMed  Google Scholar 

  14. Chiesa R, Melissano G, Marrocco-Trischitta MM et al. Spinal cord ischemia after elective stent-graft repair of the thoracic aorta. J Vasc Surg 2005;42:11–17

    Article  PubMed  Google Scholar 

  15. Black SA, Wolfe JH, Clark M et al. Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg 2006;43:1081–1089

    Article  PubMed  Google Scholar 

  16. Böckler D, Kotelis D, Geisbüsch P et al. Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections — a single center experience in 28 patients. J Vasc Surg 2008;47:724–732

    Article  PubMed  Google Scholar 

  17. Resch TA, Greenberg RK, Lyden SP et al. Combined staged procedures for the treatment of thoracoabdominal aneurysms. J Endovasc Ther 2006;13:481–489

    Article  PubMed  Google Scholar 

  18. Lee WA, Brown MP, Martin TD et al. Early results after staged hybrid repair of thoracoabdominal aortic aneurysms. J Am Coll Surg 2007;205:420–431

    Article  PubMed  Google Scholar 

  19. Zhou W, Reardon M, Peden EK et al. Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: surgical challenges and clinical outcomes. J Vasc Surg 2006;44:688–693

    Article  PubMed  Google Scholar 

  20. Chiesa R, Tshomba Y, Melissano G et al. Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery. J Vasc Surg 2007;45:1128–1135

    Article  PubMed  Google Scholar 

  21. Tshomba Y, Bertoglio L, Marone EM et al. Visceral aortic patch aneurysm after thoracoabdominal aortic repair: conventional vs hybrid treatment. J Vasc Surg 2008;48:1083–1091

    Article  PubMed  Google Scholar 

  22. Kahlberg A, Marrocco-Trischitta MM, Marone EM et al. An unusual case of dysphagia after endovascular exclusion of thoracoabdominal aortic aneurysm. J Endovasc Ther 2009;16:238–242

    Article  PubMed  Google Scholar 

  23. Tshomba Y, Melissano G, Civilini E et al. Fate of the visceral aortic patch after thoracoabdominal aortic repair. Eur J Vasc Endovasc Surg 2005;29:383–389

    PubMed  CAS  Google Scholar 

  24. Muehling BM, Bischoff G, Schelzig H et al. Hybrid procedures for complex thoracoabdominal aortic aneurysms: early results and secondary interventions. Vasc Endovascular Surg 2010;44:110–115

    Article  PubMed  Google Scholar 

  25. Wolf O, Eckstein HH. Combined open and endovascular treatment of thoracoabdominal aneurysms and secondary expanding aortic dissections: early and mid-term results from a single-center series. Ann Vasc Surg 2010;24:167–177

    Article  PubMed  Google Scholar 

  26. Nawa Y, Masuda Y, Imaizumi H et al. Comparison of surgical versus endovascular stent-graft repair of thoracic and thoracoabdominal aortic aneurysms in terms of postoperative organ failure. Masui 2004;53:1253–1258

    PubMed  Google Scholar 

  27. Kawaharada N, Morishita K, Fukada J et al. Thoracoabdominal aortic aneurysm repair through redo left-sided thoracotomy. Ann Thorac Surg 2004;77:1304–1308

    Article  PubMed  Google Scholar 

  28. Kawaharada N, Morishita K, Fukada J et al. Surgical treatment of thoracoabdominal aortic aneurysm after repairs of descending thoracic or infrarenal abdominal aortic aneurysm. Eur J Cardiothorac Surg 2001;20:520–526

    Article  PubMed  CAS  Google Scholar 

  29. Menard MT, Nguyen LL, Chan RK et al. Thoracovisceral segment aneurysm repair after previous infrarenal abdominal aortic aneurysm surgery. J Vasc Surg 2004;39:1163–1170

    Article  PubMed  Google Scholar 

  30. Baril DT, Carroccio A, Ellozy SH et al. Endovascular thoracic aortic repair and previous or concomitant abdominal aortic repair: is the increased risk of spinal cord ischemia real? Ann Vasc Surg 2006;20:188–194

    Article  PubMed  Google Scholar 

  31. Böckler D, Kotelis D, Kohlhof Pet al. Spinal cord ischemia after endovascular repair of the descending thoracic aorta in a sheep model. Eur J Vasc Endovasc Surg 2007;34:461–469

    Article  PubMed  Google Scholar 

  32. Carroccio A, Marin ML, Ellozy S, Hollier LH. Pathophysiology of paraplegia following endovascular thoracic aortic aneurysm repair. J Card Surg 2003;18:359–366

    Article  PubMed  Google Scholar 

  33. Greenberg RK, Resch T, Nyman U et al. Risk of spinal ischemia after endograft repair of thoracic aortic aneurysm. J Vasc Surg 2001;31:147–156

    Article  Google Scholar 

  34. Chiesa R, Melissano G, Bertoglio L et al. The risk of spinal cord ischemia during thoracic aorta endografting. Acta Chir Belg 2008;108:492–502

    PubMed  CAS  Google Scholar 

  35. Chiesa R, Tshomba Y, Melissano G, Logaldo D. Is hybrid procedure the best treatment option for thoraco-abdominal aortic aneurysm? Eur J Vasc Endovasc Surg 2009;38:26–34

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, “Vita-Salute” University, IRCCS H. San Raffaele, Milan, Italy

    Roberto Chiesa, Yamume Tshomba, Germano Melissano & Davide Logaldo

Authors
  1. Roberto Chiesa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yamume Tshomba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Germano Melissano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Davide Logaldo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Vascular Surgery, “Vita-Salute” University, IRCCS H., San Raffaele, Milan, Italy

    Roberto Chiesa , Germano Melissano  & Alberto Zangrillo ,  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Italia

About this chapter

Cite this chapter

Chiesa, R., Tshomba, Y., Melissano, G., Logaldo, D. (2011). Hybrid Procedures forThoraco-Abdominal Aortic Aneurysm. In: Chiesa, R., Melissano, G., Zangrillo, A. (eds) Thoraco-Abdominal Aorta. Springer, Milano. https://doi.org/10.1007/978-88-470-1857-0_37

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1857-0_37

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1856-3

  • Online ISBN: 978-88-470-1857-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation