Early outcomes of hybrid endovascular repair for distal aortic arch aneurysm at Chiangrai Prachanukroh Hospital
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Abstract
BACKGROUND: Conventional surgical repair of distal aortic arch aneurysm carries high risk and significant morbidity, particularly in high-risk patients. Hybrid endovascular repair offers a less invasive alternative with reduced perioperative risk.
OBJECTIVE: To evaluate the early outcomes of hybrid endovascular repair for aortic arch aneurysm at Chiangrai Prachanukroh Hospital.
METHODS: A retrospective study was conducted among patients who underwent hybrid endovascular repair for aortic arch aneurysm between July 2023 and April 2025. Patient data were collected from medical records, including clinical characteristics, surgical techniques, and early outcomes. Data were analyzed using descriptive statistics.
RESULTS: 8 patients were included, comprising 5 females (62.5%), with a mean age of 70.4 years. The most common comorbidity was hypertension (87.5%), and 37.5% of patients had a history of smoking. The mean estimated glomerular filtration rate (eGFR) was 60.4 ml/min/1.73m². Five patients (62.5%) underwent emergency surgery, including one case of aortic dissection and four cases of aneurysm, while three patients (37.5%) underwent elective surgery. The mean aneurysm diameter was 6.4 cm (range 4.5–11 cm). Surgical techniques included carotid-carotid-left subclavian artery (LSCA) bypass in 37.5%, carotid-LSCA bypass in 50%, and innominate artery translocation via median sternotomy in two cases. All procedures were performed as one-stage operations. The proximal landing zones were zone 0 in 2 patients, zone 1 in 3 patients, and zone 2 in 3 patients. Postoperatively, one patient (12.5%) developed stroke. The mean intensive care unit (ICU) stay was 6.9 days, and the mean hospital stay was 8.4 days.
CONCLUSIONS AND RECOMMENDATIONS: Hybrid endovascular repair is a suitable and safe treatment option for patients with distal aortic arch aneurysm, particularly those at high surgical risk. However, this study was limited by its short follow-up duration and small sample size. Further studies with long-term follow-up and larger sample sizes are needed to evaluate the durability of the repair and potential complications.
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References
Jim J, Moon MR, Rubin BG, Sicard GA, Sanchez LA. Hybrid repair of distal arch aortic aneurysms: endovascular elephant trunk completion. Ann Vasc Surg. 2011;25(5):598-604.
Dotter CT. Transluminally-placed coilspring endarterial tube grafts. Long-term patency in canine popliteal artery. Invest Radiol. 1969;4(5):329-32.
Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6):491-9.
Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331(26):1729-34.
Mitchell RS, Dake MD, Sembra CP, Fogarty TJ, Zarins CK, Liddel RP, et al. Endovascular stent-graft repair of thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 1996;111(5):1054-62.
Lioupis C, Abraham CZ. Results and challenges for the endovascular repair of aortic arch aneurysms. Perspect Vasc Surg Endovasc Ther. 2011;23(3):202-13.
Shijo T, Kuratani T, Torikai K, Shimamura K, Sakamoto T, Kudo T, et al. Thoracic endovascular aortic repair for degenerative distal arch aneurysm can be used as a standard procedure in high-risk patients. Eur J Cardiothorac Surg. 2016;50(2):257-63.
Joo HC, Youn YN, Ko YG, Choi D, Won JY, Lee DY, et al. Comparison of open surgical versus hybrid endovascular repair for descending thoracic aortic aneurysms with distal arch involvement. J Thorac Dis. 2018;10(6):3548-57.
Kawaguchi S, Yokoi Y, Shimazaki T, Koide K, Matsumoto M, Shigematsu H. Thoracic endovascular aneurysm repair in Japan: Experience with fenestrated stent grafts in the treatment of distal arch aneurysms. J Vasc Surg. 2008;48(6 Suppl):24-9S.
Ishimaru S, Kawaguchi S, Koizumi N, Obitsu Y, Ishikawa M. Preliminary report on prediction of spinal cord ischemia in endovascular stent graft repair of thoracic aortic aneurysm by retrievable stent graft. J Thorac Cardiovasc Surg. 1998;115(4):811-8.
Tian DH, Ha H, Joshi Y, Yan TD. Long-term outcomes of the frozen elephant trunk procedure: a systematic review. Ann Cardiothorac Surg. 2020;9(3):144-51.
Vekstein AM, Jensen CW, Weissler EH, Downey PS, Kang L, Gaca JG, et al. Long-term outcomes for hybrid aortic arch repair. J Vasc Surg. 2024;79(4):711-20.
Moulakakis KG, Mylonas SN, Markatis F, Kotsis T, Kakisis J, Liapis CD. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg. 2013;2(3):247-60.
Kudo T, Kuratani T, Shimamura K, Sawa Y. Determining the optimal technique for hybrid arch repair. Ann Cardiothorac Surg. 2018;7(4):403-9.
Kouvelos G, Koutsoumpelis A, Lazaris A, Matsagkas M. Hybrid procedures in the treatment of thoracic aortic diseases. J Vasc Surg. 2017;66(6):1798-807.
Kotelis D, Geisbüsch P, Attigah N, Hinz U, Hyhlik-Dürr A, Böckler D. Total vs hemi-aortic arch transposition for hybrid aortic arch repair. J Vasc Surg. 2011;54(4):1182-6.
Vallejo N, Rodriguez-Lopez JA, Heidari P, Wheatley G, Caparrelli D, Ramaiah V, et al. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg. 2012;55(2):318-25.
Song K, Kim YS, Jang WS, Chung S, Cho YH, Jeong DS, et al. Total arch replacement versus hybrid operation for aortic arch aneurysm in elderly patients: a retrospective cohort analysis. J Thorac Dis. 2023;15(8):4357-66.
