"Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results

G. Chad Hughes, Mani A. Daneshmand, Keki R. Balsara, Hardean A. Achneck, Bantayehu Sileshi, Sean Lee, Richard L. McCann

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Abstract

Background: Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. We present our results with a combined open/endovascular approach ("hybrid repair") in such patients. Methods: From August 11, 2005, to September 18, 2008, 28 patients underwent hybrid arch repair. For patients (n = 9) with distal arch aneurysms but 2 cm or more of proximal landing zone (PLZ) distal to the innominate artery, right to left carotid-carotid bypass was performed to create a PLZ by covering the left carotid origin. For patients (n = 12) with mid arch aneurysms but 2 cm or more of PLZ in the ascending aorta, proximal ascending aorta-based arch debranching was performed. For patients (n = 7) with arch aneurysms with no adequate PLZ ("mega aorta") but adequate distal landing zone, a stage 1 elephant trunk procedure was performed to create a PLZ. For the first two groups, endovascular aneurysm exclusion and debranching were performed concomitantly, whereas the procedures were staged for the group undergoing an initial elephant trunk procedure. Results: Mean patient age was 64 ± 13 years. Primary technical success rate was 100%. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 0%, 0%, and 3.6% (n = 1), respectively. At a mean follow-up of 14 ± 11 months, there have been no late aortic-related events. Two patients (7%) required secondary endovascular reintervention for a type 1 endovascular leak. No patient has a type 1 or 3 endovascular leak at latest follow-up. Conclusions: Hybrid repair of transverse aortic arch aneurysms appears safe and effective at midterm follow-up and may represent a technical advance in the treatment of this pathology.

Original languageEnglish (US)
Pages (from-to)1882-1888
Number of pages7
JournalAnnals of Thoracic Surgery
Volume88
Issue number6
DOIs
StatePublished - Dec 1 2009

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Thoracic Aorta
Aneurysm
Aorta
Brachiocephalic Trunk
Aortic Aneurysm
Paraplegia
Paresis
Stroke
Pathology
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hughes, G. C., Daneshmand, M. A., Balsara, K. R., Achneck, H. A., Sileshi, B., Lee, S., & McCann, R. L. (2009). "Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results. Annals of Thoracic Surgery, 88(6), 1882-1888. https://doi.org/10.1016/j.athoracsur.2009.07.027

"Hybrid" Repair of Aneurysms of the Transverse Aortic Arch : Midterm Results. / Hughes, G. Chad; Daneshmand, Mani A.; Balsara, Keki R.; Achneck, Hardean A.; Sileshi, Bantayehu; Lee, Sean; McCann, Richard L.

In: Annals of Thoracic Surgery, Vol. 88, No. 6, 01.12.2009, p. 1882-1888.

Research output: Contribution to journalArticle

Hughes, GC, Daneshmand, MA, Balsara, KR, Achneck, HA, Sileshi, B, Lee, S & McCann, RL 2009, '"Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results', Annals of Thoracic Surgery, vol. 88, no. 6, pp. 1882-1888. https://doi.org/10.1016/j.athoracsur.2009.07.027
Hughes GC, Daneshmand MA, Balsara KR, Achneck HA, Sileshi B, Lee S et al. "Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results. Annals of Thoracic Surgery. 2009 Dec 1;88(6):1882-1888. https://doi.org/10.1016/j.athoracsur.2009.07.027
Hughes, G. Chad ; Daneshmand, Mani A. ; Balsara, Keki R. ; Achneck, Hardean A. ; Sileshi, Bantayehu ; Lee, Sean ; McCann, Richard L. / "Hybrid" Repair of Aneurysms of the Transverse Aortic Arch : Midterm Results. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 6. pp. 1882-1888.
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abstract = "Background: Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. We present our results with a combined open/endovascular approach ({"}hybrid repair{"}) in such patients. Methods: From August 11, 2005, to September 18, 2008, 28 patients underwent hybrid arch repair. For patients (n = 9) with distal arch aneurysms but 2 cm or more of proximal landing zone (PLZ) distal to the innominate artery, right to left carotid-carotid bypass was performed to create a PLZ by covering the left carotid origin. For patients (n = 12) with mid arch aneurysms but 2 cm or more of PLZ in the ascending aorta, proximal ascending aorta-based arch debranching was performed. For patients (n = 7) with arch aneurysms with no adequate PLZ ({"}mega aorta{"}) but adequate distal landing zone, a stage 1 elephant trunk procedure was performed to create a PLZ. For the first two groups, endovascular aneurysm exclusion and debranching were performed concomitantly, whereas the procedures were staged for the group undergoing an initial elephant trunk procedure. Results: Mean patient age was 64 ± 13 years. Primary technical success rate was 100{\%}. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 0{\%}, 0{\%}, and 3.6{\%} (n = 1), respectively. At a mean follow-up of 14 ± 11 months, there have been no late aortic-related events. Two patients (7{\%}) required secondary endovascular reintervention for a type 1 endovascular leak. No patient has a type 1 or 3 endovascular leak at latest follow-up. Conclusions: Hybrid repair of transverse aortic arch aneurysms appears safe and effective at midterm follow-up and may represent a technical advance in the treatment of this pathology.",
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AU - Balsara, Keki R.

AU - Achneck, Hardean A.

AU - Sileshi, Bantayehu

AU - Lee, Sean

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N2 - Background: Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. We present our results with a combined open/endovascular approach ("hybrid repair") in such patients. Methods: From August 11, 2005, to September 18, 2008, 28 patients underwent hybrid arch repair. For patients (n = 9) with distal arch aneurysms but 2 cm or more of proximal landing zone (PLZ) distal to the innominate artery, right to left carotid-carotid bypass was performed to create a PLZ by covering the left carotid origin. For patients (n = 12) with mid arch aneurysms but 2 cm or more of PLZ in the ascending aorta, proximal ascending aorta-based arch debranching was performed. For patients (n = 7) with arch aneurysms with no adequate PLZ ("mega aorta") but adequate distal landing zone, a stage 1 elephant trunk procedure was performed to create a PLZ. For the first two groups, endovascular aneurysm exclusion and debranching were performed concomitantly, whereas the procedures were staged for the group undergoing an initial elephant trunk procedure. Results: Mean patient age was 64 ± 13 years. Primary technical success rate was 100%. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 0%, 0%, and 3.6% (n = 1), respectively. At a mean follow-up of 14 ± 11 months, there have been no late aortic-related events. Two patients (7%) required secondary endovascular reintervention for a type 1 endovascular leak. No patient has a type 1 or 3 endovascular leak at latest follow-up. Conclusions: Hybrid repair of transverse aortic arch aneurysms appears safe and effective at midterm follow-up and may represent a technical advance in the treatment of this pathology.

AB - Background: Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. We present our results with a combined open/endovascular approach ("hybrid repair") in such patients. Methods: From August 11, 2005, to September 18, 2008, 28 patients underwent hybrid arch repair. For patients (n = 9) with distal arch aneurysms but 2 cm or more of proximal landing zone (PLZ) distal to the innominate artery, right to left carotid-carotid bypass was performed to create a PLZ by covering the left carotid origin. For patients (n = 12) with mid arch aneurysms but 2 cm or more of PLZ in the ascending aorta, proximal ascending aorta-based arch debranching was performed. For patients (n = 7) with arch aneurysms with no adequate PLZ ("mega aorta") but adequate distal landing zone, a stage 1 elephant trunk procedure was performed to create a PLZ. For the first two groups, endovascular aneurysm exclusion and debranching were performed concomitantly, whereas the procedures were staged for the group undergoing an initial elephant trunk procedure. Results: Mean patient age was 64 ± 13 years. Primary technical success rate was 100%. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 0%, 0%, and 3.6% (n = 1), respectively. At a mean follow-up of 14 ± 11 months, there have been no late aortic-related events. Two patients (7%) required secondary endovascular reintervention for a type 1 endovascular leak. No patient has a type 1 or 3 endovascular leak at latest follow-up. Conclusions: Hybrid repair of transverse aortic arch aneurysms appears safe and effective at midterm follow-up and may represent a technical advance in the treatment of this pathology.

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