Hybrid Repair for Thoraco-Abdominal Aortic Diseases: Benefits of a Staged Treatment Strategy

Abstract

Objectives: We described short- and mid-term outcomes of hybrid thoraco-abdominal aortic aneurysm repair (HTAR), combining visceral debranching and thoracic endovascular aortic repair (TEVAR).

Methods: This multicentric, retrospective cohort study analysed prospectively collected data from 2 Italian referral centres on patients undergoing HTAR with at least one renal artery bypass between 2003 and 2024. These patients were deemed unfit for open surgery. Primary outcomes were early (≤30 days) and mid-term survival, and freedom from aorta-related mortality (ARM). Secondary outcomes included spinal cord injury (SCI), freedom from reintervention, and bypass patency.

Results: The population included 86 patients, 12 (13.9%) of which were urgent. Median age was 69 years. In-hospital mortality occurred in 20 patients (23.3%), with major complications in 33 (38.4%), mainly acute kidney injury (AKI) (20; 23.3%) and pneumonia (9; 10.5%). Spinal cord injury rate was 5.8%. A 2-stage strategy was used in 68 patients (79.1%). Median follow-up was 17.5 months. At 1-, 2-, and 5-years, survival was 68.6%, 67%, and 50.9%, freedom from ARM was 82.4%, 82.4%, and 82.4%; freedom from reintervention was 97.4%, 97.4%, and 87.7%, and patency was 95%, 89%, and 84%. Late reintervention occurred in 12.1% of patients. Female gender and rupture were significant predictors of reintervention and mortality, respectively. Quartile of experience correlated with improved outcomes.

Conclusions: HTAR provides an alternative to open repair in high-risk thoracoabdominal aortic aneurysm (TAAA) patients, with acceptable early and mid-term outcomes. While in-hospital mortality remains notable, SCI rates are low thanks to the 2-stage approach, and freedom from ARM and bypass patency are satisfactory.

Irb approval: No. 121/2022/Disp/AUOBo/10/2023.

Keywords: TEVAR; aneurysm; aorta; hybrid repair; thoracoabdominal; vascular.