RESUMO
ABSTRACT Introduction: The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods: Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results: Patients' mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion: Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.
RESUMO
INTRODUCTION: The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. METHODS: Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. RESULTS: Patients' mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. CONCLUSION: Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.
Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Implante de Prótese Vascular/métodos , Prótese Vascular , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/etiologia , Procedimentos Endovasculares/efeitos adversos , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Stents , Desenho de PróteseRESUMO
AIM: We present our subclavian artery revascularization experiences in the patients with thoracic aortic aneurysm who underwent hybrid repair. MATERAIL AND METHODS: Between May 2015-December 2018,4 patients underwent TEVAR procedure following axilloaxillary bypass grafting.The mean age of the patients was 72.5 ± 3.01 years.One patient was female and 3 patients were male.Patients had thoracic aortic aneurysms including the left subclavian artery or aberrant right subclavian artery. RESULTS: All patients underwent endovascular stent graft repair following axilloaxillary bypass grafting in the same day.Mortality did not occur in the perioperative period.One patient had graft infection at 8th month of the operation and the graft was removed.He was lost due to pneumonia following the operation.The control computed tomographies of the other 3 patients revealed patent grafts together with successful endovascular interventions and they have been following uneventfully a mean of 27±6.2 months (range:24-32,median:29). CONCLUSION: The risk of stroke,spinal cord ischemia, and upper extremity ischemia are found higher in the patients who underwent coverage of the left subclavian artery without revascularization.The axilloaxillary bypass grafting may be performed in the patients with high risk to prevent carotid artery manipulation and clamping during carotid-subclavian bypass with long term promising patency rates.
OBJETIVO: Presentamos nuestras experiencias de revascularización de la arteria subclavia en los pacientes con aneurisma de aorta torácica sometidos a reparación híbrida. MATERIAL Y MÉTODOS: entre mayo de 2015 y diciembre de 2018, 4 pacientes fueron sometidos a TEVAR después de un injerto de derivación axiloaxilar. La edad media de los pacientes fue 72,5 ± 3,01 años. Un paciente era mujer y 3 pacientes eran varones. Los pacientes tenían aneurismas de la aorta torácica incluyendo el arteria subclavia izquierda o arteria subclavia derecha aberrante. RESULTADOS: Todos los pacientes fueron sometidos a reparación endovascular con endoprótesis vascular en el mismo día después de un bypass axiloaxilar, no hubo mortalidad en el perioperatorio, un paciente presentó infección del injerto a los 8 meses de la operación y se retiró el injerto, se perdió por neumonía Las tomografías computarizadas de control de los otros 3 pacientes revelaron injertos permeables junto con intervenciones endovasculares exitosas y han estado siguiendo sin incidentes una media de 27 ± 6,2 meses (rango: 24-32, mediana: 29). CONCLUSIÓN: El riesgo de ictus, isquemia medular e isquemia de la extremidad superior es mayor en los pacientes sometidos a cobertura de la arteria subclavia izquierda sin revascularización; en los pacientes con alto riesgo se puede realizar un bypass axiloaxilar para prevenir la manipulación de la arteria carótida. y pinzamiento durante la derivación carótido-subclavia con tasas de permeabilidad prometedoras a largo plazo.