Hybrid Reconstruction of Thoracoabdominal Aortic Aneurysms: Retrograde Visceral Revascularization with Endovascular Exclusion

Methods: It is a retrospective review of a prospectively collected database of 11 consecutive patients (4 women), with a median patient age of 71 years (range 41 to 77 years). All patients underwent hybrid reconstruction of thoracoabdominal aortic aneurysms (Crawford type II in 3 and type III in 8 patients) in the period between November 2006 and November 2007. Seven patients underwent elective repair, 3 patients were symptomatic and underwent urgent repair, and 1 patient had an emergency repair for rupture. Previous aortic surgery had been performed in 3 patients. One or more severe comorbidities were present in 82% of patients (9/11); six patients had moderate to severe respiratory insufficiency, 4 patients had moderate to severe left ventricular dysfunction, and 5 patients had chronic renal impairment. One patient had Marfan s syndrome. A total of 40 visceral bypasses were performed: these included 11 to the superior mesenteric artery (SMA). 11 to the coeliac trunk (CA) and 18 renal artery (RA) bypasses (bilateral in 7 patients and single in 4). Aneurysm exclusion was achieved with a median of 2 stent-grafts per patient.