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. 2014 Oct-Dec;29(4):527-36.
doi: 10.5935/1678-9741.20140056.

Hybrid treatment of aortic arch disease

[Article in English, Portuguese]
Patrick Bastos Metzger  1 , Fabio Henrique Rossi  1 , Samuel Martins Moreira  2 , Mario Issa  3 , Nilo Mitsuru Izukawa  4 , Jarbas J Dinkhuysen  1 , Domingos Spina Neto  5 , Antônio Massamitsu Kambara  6
Affiliations

Hybrid treatment of aortic arch disease

[Article in English, Portuguese]
Patrick Bastos Metzger et al. Rev Bras Cir Cardiovasc. 2014 Oct-Dec.

Abstract
in English, Portuguese

Introduction: The management of thoracic aortic disease involving the ascending aorta, aortic arch and descending thoracic aorta are technically challenging and is an area in constant development and innovation.

Objective: To analyze early and midterm results of hybrid treatment of arch aortic disease.

Methods: Retrospective study of procedures performed from January 2010 to December 2012. The end points were the technical success, therapeutic success, morbidity and mortality, neurologic outcomes, the rate of endoleaks and reinterventions.

Results: A total of 95 patients treated for thoracic aortic diseases in this period, 18 underwent hybrid treatment and entered in this study. The average ages were 62.3 years. The male was present in 66.7%. The technical and therapeutic success was 94.5% e 83.3%. The perioperative mortality rate of 11.1%. There is any death during one-year follow- up. The reoperation rates were 16.6% due 2 cases of endoleak Ia and one case of endoleak II. There is any occlusion of anatomic or extra anatomic bypass during follow up.

Conclusion: In our study, the hybrid treatment of aortic arch disease proved to be a feasible alternative of conventional surgery. The therapeutic success rates and re- interventions obtained demonstrate the necessity of thorough clinical follow-up of these patients in a long time.

Introdução: O manejo das doenças da aorta torácica que envolvem a aorta ascendente, arco aórtico e aorta torácica descendente constituem um desafio técnico e é uma área em constante desenvolvimento e inovação.

Objetivo: Analisar os resultados iniciais e a médio prazo do tratamento híbrido das doenças do arco aórtico.

Métodos: Estudo retrospectivo de procedimentos realizados no período de janeiro de 2010 a dezembro de 2012, em que foram analisados o sucesso técnico e terapêutico, a morbimortalidade, os desfechos neurológicos, a taxa de vazamentos e de reintervenções.

Resultados: Em um total de 95 pacientes tratados por doenças da aorta torácica no período, 18 realizaram o tratamento híbrido e adentraram neste estudo. A idade média foi de 62,3 anos. O sexo masculino esteve presente em 66,7%. O sucesso técnico e terapêutico foi de 94,5% obe 83,3%, respectivamente. A mortalidade perioperatória foi de 11,1%. Não houve óbito durante o acompanhamento de 1 ano. A taxa de reintervenção foi de 16,6%, devido a 2 casos de endoleak tipo Ia e um caso de endoleak tipo 2. Não foi observada oclusão dos enxertos anatômicos ou extra-anatômicos durante o período de seguimento.

Conclusão: O tratamento híbrido das doenças do arco aórtico demonstrou ser uma alternativa viável à cirurgia convencional. As taxas de sucesso terapêutico e de reintervenções demonstram a necessidade do seguimento clínico rigoroso desses pacientes a longo prazo.

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Figures

Fig. 1
Fig. 1
Angiotomography with multiplanar and three-dimensional reconstruction A: Axial section demonstrating the dissection of the left subclavian artery origin. B: Larger diameter of the aorta. C: Sagittal section. D: Superior mesenteric artery originating from the true light. E: Involvement of the abdominal aorta. F: Dissection at the level of the left iliac artery. G: Three-dimensional reconstruction of the left anterior oblique. H: Threedimensional reconstruction of the right anterior oblique
Fig. 2
Fig. 2
Anchoring zones of the thoracic aneurysm according to Ishimaru and Mitchell classification
Fig. 3
Fig. 3
Carotid-left subclavian graft with prosthesis anchoring in Zone 2. A=Angiotomography in axial section showing massive thoracic aneurysm without proximal landing zone. B=Three-dimensional reconstruction of pre-implanted stents. C=Digital subtraction angiotomography with endoprosthesis anchoring in Zone 2 and carotid-suclavian patent graft. D=Three-dimensional angiographic reconstruction after stent implantation without leaks
Fig 4
Fig 4
Carotid-carotid graft associated with transposition of the left subclavian artery and stent-graft implantation in Zone 1. A: Angiotomography in sagittal section with thoracic aneurysm without proper anchoring zone in Zone 2 due to extreme proximity between the left carotid and the left subclavian arteries. B: Angiotomography in axial section showing massive thoracic aneurysm. C: Angiotomography with volume reconstruction. D: Supra-aortic trunk revascularizatoins with carotid-carotid graft associated with transposition of the left subclavian artery. E: Aortography before stent implantation with patency of anatomical extra grafts. F: Aortography after stent implantation demonstrating the aortic stent in Zone 1, no leaks and patency of supra-aortic trunks
Fig. 5
Fig. 5
Brachiocephalic ascending aorta graft associated with carotid-carotid graft placement of vascular plug and aortic endoprosthesis implantation in Zone 0. Intentional occlusion of left subclavian artery
See this image and copyright information in PMC

References

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