Single<b>-</b>center experience with hybrid surgery for thoracoabdominal aortic aneurysm in West China Hospital_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHAO Jichun ,  HUANG Bin , YUAN Ding , YANG Yi , XIONG Fei , CHEN Xiyang , DU Xiaojiong , WANG Tiehao , GUO Qiang , HU Hankui , HU Huanrui , WANG Jiarong

Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

ZHAO Jichun, Email: zhaojc3@163.com

Keywords：

thoracoabdominal aortic aneurysm; hybrid surgery; treatment; single-center experience

DOI：

10.7507/1007-9424.202404053

Video：

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Objective To explore the efficacy and safety of hybrid surgery in the treatment of thoracoabdominal aortic aneurysm (TAAA). Methods Twenty patients who were diagnosed with TAAA (including chronic thoracoabdominal aortic dissection aneurysm) and underwent hybrid surgery in Vascular Surgery, West China Hospital, Sichuan University were enrolled between January 2015 and December 2022. All the patients underwent retrograde reconstruction for visceral arteries in the open surgery. Additionally, one-stage or two-stage endovascular aortic repair with covered stents was performed. The patients’ clinical baseline information was collected. Moreover, the patients received clinical follow-up and imaging examinations postoperatively, whose informationwas collected. Results One patient developed paraplegia and acute renal failure 16 days postoperatively in the hospital, and subsequently died in the hospital due to septic shock. Another patient underwent exploratory laparotomy for hemostasis due to anastomotic bleeding in the hospital. The other patients did not experience serious complications perioperatively. Nineteen patients were discharged from the hospital with long-term follow-up ranging from 10 to 144 months (median time: 48 months), and all of them had a long-term survival. No patients were observed with paraplegia, myocardial infarction, stroke, or rupture of aneurysm. None of the patients received reintervention during the follow-up, except for one patient who underwent ultrasound-guided puncture and suctionin the aneurysmallumen. Conclusion Hybrid surgery is an effective treatment for TAAA with favorable short- and long-term safety and efficacy.

Citation： ZHAO Jichun, HUANG Bin, YUAN Ding, YANG Yi, XIONG Fei, CHEN Xiyang, DU Xiaojiong, WANG Tiehao, GUO Qiang, HU Hankui, HU Huanrui, WANG Jiarong. Single-center experience with hybrid surgery for thoracoabdominal aortic aneurysm in West China Hospital. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 671-675. doi: 10.7507/1007-9424.202404053 Copy

1.	Tenorio ER, Dias-Neto MF, Lima GBB, et al. Endovascular repair for thoracoabdominal aortic aneurysms: current status and future challenges. Ann Cardiothorac Surg, 2021, 10(6): 744-767.
2.	Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.334-482. doi: 10.1161/CIR.0000000000001106.
3.	Girardi LN, Lau C, Ohmes LB, et al. Open repair of descending and thoracoabdominal aortic aneurysms in octogenarians. J Vasc Surg, 2018, 68(5): 1287-1296.
4.	Ferrer C, Cao P, De Rango P, et al. A propensity-matched comparison for endovascular and open repair of thoracoabdominal aortic aneurysms. J Vasc Surg, 2016, 63(5): 1201-1207.
5.	Dias-Neto M, Tenorio ER, Huang Y, et al. Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms. J Vasc Surg, 2023, 77(6): 1588-1597.
6.	Dias-Neto M, Vacirca A, Huang Y, et al. Outcomes of elective and non-elective fenestrated-branched endovascular aortic repair for treatment of thoracoabdominal aortic aneurysms. Ann Surg, 2023, 278(4): 568-577.
7.	Chan XW, Masuda Y, M T L Choong A, et al. A systematic review and meta-analysis of total endovascular versus hybrid repair for the treatment of thoracoabdominal aortic aneurysms. J Vasc Surg, 2023, S0741-5214(23): 02305-4. doi: 10.1016/j.jvs.2023.11.047. Online ahead of print. doi: 10.1016/j.jvs.2023.11.047.Onlineaheadofprint.
8.	Liu T, Zhao J, Sun J, et al. Comparison of efficiency and safety of open surgery, hybrid surgery and endovascular repair for the treatment of thoracoabdominal aneurysms: a systemic review and network meta-analysis. Front Cardiovasc Med, 2023, 10: 1257628. doi: 10.3389/fcvm.2023.1257628.
9.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
10.	吳明煒, 曾照祥, 趙玉璽, 等. 腔內技術治療胸腹主動脈瘤的進展. 中國血管外科雜志(電子版), 2020, 12(1): 63-65.
11.	Shimamura J, Oshima S, Ozaki K, et al. Open thoracoabdominal aortic aneurysm repair: contemporary outcomes for 393 elective cases. Ann Thorac Surg, 2019, 107(5): 1326-1332.
12.	Rocha RV, Lindsay TF, Austin PC, et al. Outcomes after endovascular versus open thoracoabdominal aortic aneurysm repair: A population-based study. J Thorac Cardiovasc Surg, 2021, 161(2): 516-527.
13.	Rigberg DA, McGory ML, Zingmond DS, et al. Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: a statewide experience. J Vasc Surg, 2006, 43(2): 217-222.
14.	Gaudino M, Khan FM, Rahouma M, et al. Spinal cord injury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: A meta-analysis. J Thorac Cardiovasc Surg, 2022, 163(2): 552-564.
15.	Harik L, Lau C. Open and endovascular repair of thoracoabdominal aortic aneurysm—a narrative review. J Thorac Dis, 2023, 15(7): 3984-3997.
16.	Khoury MK, Acher C, Wynn MM, et al. Long-term survival after descending thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg, 2021, 74(3): 843-850.
17.	Qui?ones-Baldrich WJ, Panetta TF, Vescera CL, et al. Repair of type Ⅳ thoracoabdominal aneurysm with a combined endovascular and surgical approach. J Vasc Surg, 1999, 30(3): 555-560.
18.	Arnaoutakis DJ, Scali ST, Beck AW, et al. Comparative outcomes of open, hybrid, and fenestrated branched endovascular repair of extentⅡ and Ⅲ thoracoabdominal aortic aneurysms. J Vasc Surg, 2020, 71(5): 1503-1514.
19.	趙紀春, 盧武勝, 黃斌, 等. 外科和腔內雜交技術治療胸腹主動脈瘤. 中華外科雜志, 2008, 46(20): 1594-1595.
20.	吉志敏, 王鐵皓, 陳熹陽, 等. 馬凡綜合征復雜胸腹主動脈夾層動脈瘤雜交手術應用人工血管作為遠端錨定區的遠期良好效果. 中國普外基礎與臨床雜志, 2021, 28(6): 794-798.
21.	Yuan D, Zhao J, Huang B, et al. Hybrid treatment of thoracoabdominal aortic aneurysms with Marfan syndrome. J Vasc Surg, 2016, 64(4): 1138-1139.
22.	趙紀春, 盧武勝, 馬玉奎, 等. 雜交技術在胸腹主動脈瘤的治療選擇. 臨床外科雜志, 2010, 18(5): 294-297.趙紀春, 盧武勝, 馬玉奎, 等. 雜交技術在胸腹主動脈瘤的治療選擇. 臨床外科雜志, 2010, 18(5): 294-297.
23.	Chen GX, Wan JH, Chen CW, et al. Hybrid surgery management challenges of a Behcet’s disease patient with recurrence of aortic aneurysms: a case report. Front Cardiovasc Med, 2023, 10: 1097129. doi: 10.3389/fcvm.2023.1097129.
24.	謝偉, 薛云星, 李樹春, 等. 分期雜交腹主動脈去分支化治療胸腹主動脈瘤. 中華胸心血管外科雜志, 2021, 37(6): 354-357.
25.	Wang J, Wang T, Zhao J, et al. Comparison of clinical outcomes following one versus two stage hybrid repair of thoraco-abdominal aortic aneurysms: A comprehensive meta-analysis. Eur J Vasc Endovasc Surg, 2021, 61(3): 396-406.
26.	Etz CD, Zoli S, Mueller CS, et al. Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg, 2010, 139(6): 1464-1472.
27.	Gombert A, Frankort J, Keszei A, et al. Outcome of elective and emergency open thoraco-abdominal aortic aneurysm repair in 255 cases: a retrospective single centre study. Eur J Vasc Endovasc Surg, 2022, 63(4): 578-586.
28.	Patel HJ, Upchurch GR, Eliason JL, et al. Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair. Ann Thorac Surg, 2010, 89(5): 1475-1481.
29.	Hawkins RB, Mehaffey JH, Narahari AK, et al. Improved outcomes and value in staged hybrid extentⅡ thoracoabdominal aortic aneurysm repair. J Vasc Surg, 2017, 66(5): 1357-1363.
30.	van de Graaf RA, Grüne F, Hoeks SE, et al. One-year follow-up after hybrid thoracoabdominal aortic repair. Vasc Endovascular Surg, 2017, 51(1): 23-27.
31.	Moulakakis KG, Mylonas SN, Avgerinos ED, et al. Hybrid open endovascular technique for aortic thoracoabdominal pathologies. Circulation, 2011, 124(24): 2670-2680.

1. Tenorio ER, Dias-Neto MF, Lima GBB, et al. Endovascular repair for thoracoabdominal aortic aneurysms: current status and future challenges. Ann Cardiothorac Surg, 2021, 10(6): 744-767.
2. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.334-482. doi: 10.1161/CIR.0000000000001106.
3. Girardi LN, Lau C, Ohmes LB, et al. Open repair of descending and thoracoabdominal aortic aneurysms in octogenarians. J Vasc Surg, 2018, 68(5): 1287-1296.
4. Ferrer C, Cao P, De Rango P, et al. A propensity-matched comparison for endovascular and open repair of thoracoabdominal aortic aneurysms. J Vasc Surg, 2016, 63(5): 1201-1207.
5. Dias-Neto M, Tenorio ER, Huang Y, et al. Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms. J Vasc Surg, 2023, 77(6): 1588-1597.
6. Dias-Neto M, Vacirca A, Huang Y, et al. Outcomes of elective and non-elective fenestrated-branched endovascular aortic repair for treatment of thoracoabdominal aortic aneurysms. Ann Surg, 2023, 278(4): 568-577.
7. Chan XW, Masuda Y, M T L Choong A, et al. A systematic review and meta-analysis of total endovascular versus hybrid repair for the treatment of thoracoabdominal aortic aneurysms. J Vasc Surg, 2023, S0741-5214(23): 02305-4. doi: 10.1016/j.jvs.2023.11.047. Online ahead of print. doi: 10.1016/j.jvs.2023.11.047.Onlineaheadofprint.
8. Liu T, Zhao J, Sun J, et al. Comparison of efficiency and safety of open surgery, hybrid surgery and endovascular repair for the treatment of thoracoabdominal aneurysms: a systemic review and network meta-analysis. Front Cardiovasc Med, 2023, 10: 1257628. doi: 10.3389/fcvm.2023.1257628.
9. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
10. 吳明煒, 曾照祥, 趙玉璽, 等. 腔內技術治療胸腹主動脈瘤的進展. 中國血管外科雜志(電子版), 2020, 12(1): 63-65.
11. Shimamura J, Oshima S, Ozaki K, et al. Open thoracoabdominal aortic aneurysm repair: contemporary outcomes for 393 elective cases. Ann Thorac Surg, 2019, 107(5): 1326-1332.
12. Rocha RV, Lindsay TF, Austin PC, et al. Outcomes after endovascular versus open thoracoabdominal aortic aneurysm repair: A population-based study. J Thorac Cardiovasc Surg, 2021, 161(2): 516-527.
13. Rigberg DA, McGory ML, Zingmond DS, et al. Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: a statewide experience. J Vasc Surg, 2006, 43(2): 217-222.
14. Gaudino M, Khan FM, Rahouma M, et al. Spinal cord injury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: A meta-analysis. J Thorac Cardiovasc Surg, 2022, 163(2): 552-564.
15. Harik L, Lau C. Open and endovascular repair of thoracoabdominal aortic aneurysm—a narrative review. J Thorac Dis, 2023, 15(7): 3984-3997.
16. Khoury MK, Acher C, Wynn MM, et al. Long-term survival after descending thoracic and thoracoabdominal aortic aneurysm repair. J Vasc Surg, 2021, 74(3): 843-850.
17. Qui?ones-Baldrich WJ, Panetta TF, Vescera CL, et al. Repair of type Ⅳ thoracoabdominal aneurysm with a combined endovascular and surgical approach. J Vasc Surg, 1999, 30(3): 555-560.
18. Arnaoutakis DJ, Scali ST, Beck AW, et al. Comparative outcomes of open, hybrid, and fenestrated branched endovascular repair of extentⅡ and Ⅲ thoracoabdominal aortic aneurysms. J Vasc Surg, 2020, 71(5): 1503-1514.
19. 趙紀春, 盧武勝, 黃斌, 等. 外科和腔內雜交技術治療胸腹主動脈瘤. 中華外科雜志, 2008, 46(20): 1594-1595.
20. 吉志敏, 王鐵皓, 陳熹陽, 等. 馬凡綜合征復雜胸腹主動脈夾層動脈瘤雜交手術應用人工血管作為遠端錨定區的遠期良好效果. 中國普外基礎與臨床雜志, 2021, 28(6): 794-798.
21. Yuan D, Zhao J, Huang B, et al. Hybrid treatment of thoracoabdominal aortic aneurysms with Marfan syndrome. J Vasc Surg, 2016, 64(4): 1138-1139.
22. 趙紀春, 盧武勝, 馬玉奎, 等. 雜交技術在胸腹主動脈瘤的治療選擇. 臨床外科雜志, 2010, 18(5): 294-297.趙紀春, 盧武勝, 馬玉奎, 等. 雜交技術在胸腹主動脈瘤的治療選擇. 臨床外科雜志, 2010, 18(5): 294-297.
23. Chen GX, Wan JH, Chen CW, et al. Hybrid surgery management challenges of a Behcet’s disease patient with recurrence of aortic aneurysms: a case report. Front Cardiovasc Med, 2023, 10: 1097129. doi: 10.3389/fcvm.2023.1097129.
24. 謝偉, 薛云星, 李樹春, 等. 分期雜交腹主動脈去分支化治療胸腹主動脈瘤. 中華胸心血管外科雜志, 2021, 37(6): 354-357.
25. Wang J, Wang T, Zhao J, et al. Comparison of clinical outcomes following one versus two stage hybrid repair of thoraco-abdominal aortic aneurysms: A comprehensive meta-analysis. Eur J Vasc Endovasc Surg, 2021, 61(3): 396-406.
26. Etz CD, Zoli S, Mueller CS, et al. Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg, 2010, 139(6): 1464-1472.
27. Gombert A, Frankort J, Keszei A, et al. Outcome of elective and emergency open thoraco-abdominal aortic aneurysm repair in 255 cases: a retrospective single centre study. Eur J Vasc Endovasc Surg, 2022, 63(4): 578-586.
28. Patel HJ, Upchurch GR, Eliason JL, et al. Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair. Ann Thorac Surg, 2010, 89(5): 1475-1481.
29. Hawkins RB, Mehaffey JH, Narahari AK, et al. Improved outcomes and value in staged hybrid extentⅡ thoracoabdominal aortic aneurysm repair. J Vasc Surg, 2017, 66(5): 1357-1363.
30. van de Graaf RA, Grüne F, Hoeks SE, et al. One-year follow-up after hybrid thoracoabdominal aortic repair. Vasc Endovascular Surg, 2017, 51(1): 23-27.
31. Moulakakis KG, Mylonas SN, Avgerinos ED, et al. Hybrid open endovascular technique for aortic thoracoabdominal pathologies. Circulation, 2011, 124(24): 2670-2680.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Single-center experience with hybrid surgery for thoracoabdominal aortic aneurysm in West China Hospital

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