Vascular Surgery

Materials & Methods: From February 2009 to September 2016, 81 consecutive patients (70 men; mean age 63.4±7.9 years, range 32-79) underwent brachiocephalic bypass combined with stentgraft implantation (hybrid) and were enrolled in the study. Aortic pathologies included Stanford type B aortic dissection (n=22), aortic arch aneurysm (n=26), aortic arch pseudoaneurysm (n=14), aortic arch penetrating ulcer (n=11) and proximal endoleak (n=5) or pseudoaneurysm formation (n=3) after thoracic endovascular aortic repair (TEVAR). Hybrid repair comprised 3 landing in zone 0, 44 landing in zone 1 and 34 landing in zone 2. Simultaneous procedures included left subclavian artery embolization (n=57), endovascular abdominal aortic repair (n=1), coronary artery bypass (n=1), left common carotid endarterectomy (n=1) and renal stenting (n=4). Follow-up was performed at 1 month, 3 months, 6 months, 1 year and annually thereafter to investigate endoleak, patency of vascular graft and exclusion of aortic pathology. Results: Technical success was 100%. Instant endoleak was observed in 9 (11.1%, 7 type ï¼…, 2 type ï¼…) cases on postoperative angiography. Perioperative complications included iatrogenic ascending aortic dissection (n=1, 1.2%), stroke (n=2, 2.5%), anastomotic bleeding (n=1, 1.2%), both lower limbs thrombosis (n=1, 1.2%) and acute respiratory failure (n=2, 2.5%). Early morbidity was 8.6% (7/81). Early death occurred in 5 cases (6.2%) due to stroke, anastomotic bleeding, acute respiratory failure and sudden death. Follow-up was complete in 100% for 39.4±14.5 months (range 1-81 months). During follow-up, all the vascular grafts were patent. The overall endoleak rate was 13.58% (11/81). Late mortality was 6.2% (5/81) and morbidity was 14.5% (8/81). Conclusions: Hybrid repair of aortic pathologies involving aortic arch is safe and effective with good short and mid-term results, greatly expanding the indication of endovascular aortic repair.