REVIEWS  THORACIC ENDOGRAFTING MANAGEMENT AND THE OF THORACOABDOMINAL ANEURYSMS 

The Journal of Cardiovascular Surgery 2009 August;50(4):461-74

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Hybrid approach for arch and thoracoabdominal pathologies

Böckler D. ¹, Nassar J. ², Kotelis D. ¹, Geisbüsch P. ¹, Hyhlik-Dürr A. ¹, Von Tengg-Kobligk H. ³, Weber T. F. ³, Schumacher H. ²

¹ Department of Vascular and Endovascular Surgery Ruprecht-Karls University, Heidelberg, Germany 2 Clinic for Vascular and Endovascular Surgery Klinikum Hanau, Hanau, Germany 3 Department of Radiodiagnostics and Interventional Radiology, Ruprecht-Karls University Heidelberg, Germany

The endovascular era began about 20 years ago and subsequently revolutionized vascular surgery as a less invasive treatment option, especially for high risk patients. In the late 1990s, a new hybrid approach for arch and thoracoabdominal pathologies was developed. Debranching and rerouting supra-aortic and visceral aortic branches with extra-anatomic bypass grafting was performed in order to achieve sufficient landing zones demanding for subsequent stent grafting. The initial single-center results of small series up to 20 patients were encouraging with acceptable complication rates. Hybrid arch procedures are feasible but seem to carry risks. However, the latest reports for thoracoabdominal hybrid procedures demand a word of caution due to high morbidity rates. The hybrid approach may be reserved for a selected comorbid patient cohort, which is regarded unfit for open reconstruction.