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

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 tong 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. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.