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DOI: 10.1055/s-0029-1191423
Combined open proximal and stent-graft distal repair of complex aortic arch aneurysms: eight years clinical experience
Objective: We hypothesized that a combined open proximal and stent-graft distal repair of complex aortic arch aneurysms extending into the descending aorta would allow us to maintain the excellent technical results of the conventional two-stage elephant trunk procedure but reduce associated risks.
Methods: Since April 2000, 18 patients (66±18 years, 8 males) including 5 patients with Marfan syndrome were treated. Initially, the aortic arch was replaced during selective antegrade cerebral perfusion. Subsequent endovascular repair was performed retrogarde via femoral artery access 16±6 days after the initial surgery or antegrade via the ascending aorta during the same procedure (n=7). Mean follow-up was 2.8±1.6 years (maximum 8 years) and was 100% complete including 2.6±1.4 postoperative CT scans per patient.
Results: There was no operative death, no stroke, and no case of paraplegia. Intubation time and hospital stay were 21±14 hours and 9.8±4.7 days, respectively. At completion angiography no patient had an endoleak. During follow-up, there was no case of stent migration and no proximal endoleak. Two patients with Marfan syndrome developed a late type I distal endoleak. There was one late death 26 months postoperatively due to sudden death in a patient with a persistent abdominal aortic dissection.
Conclusions: Current data demonstrate excellent operative outcomes and an acceptable incidence of late morbidity and mortality following this hybrid approach. Dacron grafts routinely used for aortic arch replacement provide a safe and durable proximal landing zone for subsequent endovascular repair of extensive thoracic aortic pathologies which classically required 2 major open surgeries.