Hybrid Procedures in the Treatment of Type IV and V Thoracoabdominal Aneurysms

Czech version

Authors: P. Utíkal ¹; M. Köcher ²; J. Koutná ³; P. Bachleda ¹; P. Dráč ¹; M. Černá ²; J. Herman ¹; L. Kalinová ¹
Authors‘ workplace: II. chirurgická klinika FN a LF UP v Olomouci, přednosta: doc. MUDr. Petr Bachleda, CSc. ¹; Radiologická klinika FN a LF UP v Olomouci, přednosta: prof. MUDr. Miroslav Heřman, Ph. D. ²; Klinika anesteziologie a resuscitace FN a LF UP v Olomouci, přednosta: † MUDr. Oldřich Marek, Ph. D. ³
Published in: Rozhl. Chir., 2010, roč. 89, č. 1, s. 9-17.
Category: Monothematic special - Original

Overview

Objective:
To evaluate our experience with hybrid endovascular and open surgical treatment of thoracoabdominal aneurysms.

Material and methods:
Between 1996 and 2008 8 patients with thoracoabdominal aneurysm (6 Crawford type IV and 2 type V) from the total of 257 aortic aneurysms with elective endovascular repair were treated using hybrid procedure. A retrograde revascularisation of visceral and renal arteries through the open access and endovascular exclusion of aneurysms using a stent-graft were done.

Results:
A primar technical success of the hybrid procedure was in all cases. There was no severe ischaemia of visceral organs, kidneys (no need of haemodialysis) or spinal cord (paraplegia). One patient died on an acute pancreatitis 14 postperative day. Further follow up (in range 16–52 monthes) showed henceforth a successful exclusion of all the aneurysms without evidence of endoleak and patency of all bypasses with a good function of revascularised organs.

Conclusion:
Owing to minimal haemodynamic load and technical simplicity with a short time of organ ischaemia hybrid procedure represents an acceptable possibility of type IV and V thoracoabdominal aneurysms repair.

Key words:
thoracoabdominal aortic aneurysm – hybrid procedure – endovascular exclusion – visceral revascularisation

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