Current status of hybrid procedures for thoracoabdominal and pararenal aortic aneurysm repair: techniques and considerations

Abstract

Hybrid techniques play a role in the treatment of patients who suffer from thoracoabdominal (TAAA) and pararenal aortic aneurysms (PAAA) but are unfit for open repair. The increasing number of TAAA patients treated by hybrid approaches has brought to light the severe procedure-related morbidity that can accompany these complex repairs. To overcome these issues, several techniques have been proposed to simplify them. This article reviews the most important technical advances of hybrid TAAA/PAAA repair, focusing on (1) the surgical approach, (2) the anastomotic technique for the renovisceral bypass, (3) antegrade versus retrograde renovisceral revascularization, and (4) simultaneous versus staged visceral hybrid repair. We discuss critical issues that may influence outcomes with these advanced procedures.