ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Combined surgical and endovascular repair of thoracic and thoracoabdominal aortic aneurysms
Ali Gürbüz, İbrahim Özsöyler, Levent Yılık, Tevfik Güneş, Murat Aksun, Engin Uluç
İzmir Atatürk Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniği, İzmir
Background: Surgical treatment of thoracic aortic pathologies is associated with high mortality and morbidity rates. Mortality and morbidity rates are even higher in surgical treatment of thoracoabdominal aortic aneurysms. Combination of endovascular and open techniques may provide better results in this patient group.

Methods: The study included six patients who were treated with combined endovascular and open surgical techniques for thoracic or thoracoabdominal aortic aneurysms or dissections. Two patients had prior surgery for type I aortic dissection and had aortic dissection and false lumen expansion distal to the graft interposed in the ascending aorta. Three patients had Crawford type III thoracoabdominal aortic aneurysms. One patient had two aneurysms in the descending thoracic and abdominal aorta, respectively.

Results: Aortic arch debranching was performed in two patients with aortic dissection, and total abdominal debranching was performed in three patients with Crawford type III thoracoabdominal aortic aneurysms. In these five patients, endovascular stent graft implantation was performed in a separate session. The patient with two aneurysms in the descending and abdominal aorta did not have proper anatomy for an endovascular intervention to the abdominal aorta. Tube graft interposition was performed for abdominal aortic aneurysm followed by endovascular stent graft repair of the descending thoracic aorta. Early postoperative mortality occurred in one patient who developed a neurological complication following total abdominal debranching. The remaining patients had an uneventful early postoperative period.

Conclusion: Hybrid procedures combining open and endovascular surgical techniques may reduce mortality and morbidity rates in the treatment of descending thoracic and thoracoabdominal aortic aneurysms.

Keywords : Aortic aneurysm, abdominal/surgery; aortic aneurysm, thoracic/surgery; blood vessel prosthesis.
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