Early Results after Staged Hybrid Repair of Thoracoabdominal Aortic Aneurysms

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Abstract
The morbidity and mortality rates associated with open thoracoabdominal aortic aneurysm (TAAA) repair are substantial. This study was designed to review our early experience with the hybrid endovascular and, or open approach for TAAA repair. Patients undergoing elective hybrid repair of their TAAAs were retrospectively reviewed. Seventeen patients (mean age 69 ± 15 years, male, 76%) underwent visceral and renal revascularization as the first stage of their hybrid repair. The Crawford extent included: II, 2; III, 8; and IV, 7. Perioperative mortality and complication rates after the first stage were 24% and 25%, respectively; the mean intensive care unit stay and total length of stay were 7 ± 12 days (range 1 to 45 days) and 22 ± 33 days (range 3 to 100 days), respectively. The endovascular aneurysm repair or second stage procedure was performed in 12 of 13 (92%) of the surviving patients, with a mean of 27 ± 27 days (range 6 to 99 days) between the procedures. Two patients experienced intraoperative complications during the second stage, but there were no deaths or additional postoperative complications. Patients did not require the intensive care unit, and the overall mean length of stay after the second stage was 2 ± 2 days (range 1 to 5 days). The mean postoperative followup among the 11 patients completing both stages was 8 ± 12 months (range 1 to 15 months). The primary patency rate for the visceral and renal bypasses was 96% (54 of 56). The hybrid approach for patients with TAAAs may reduce complications in the average, low-risk patient and may extend the indications for repair to patients considered higher risk based on age, comorbidities, or anatomic considerations.