Staged hybrid repair of type II thoracoabdominal aneurysms

Abstract Introduction Type II thoracoabdominal aortic aneurysms (TAAA) open repair remains a challenging procedure. Staged procedures could decrease complications after complex aortic repair. This study describes a strategy using thoracic endovascular aortic repair (TEVAR) as proximal repair, followed by distal open repair. Methods Between 2014 and 2018, fourteen patients were treated for a type II TAAA, using TEVAR first followed by a distal open repair. All patients should have a suitable proximal landing zone according to the current guidelines. In cases of chronic dissection, a false lumen embolization was performed to achieve a total exclusion. Results The mean age was 48±15 years; five patients had Marfan syndrome (36%) and six patients had a previous aortic arch repair (43%). Ten patients had a chronic dissection. Maximal aortic diameter was 73±12 mm. The TEVAR technical success was 100%. Aortic length coverage was 211±63 mm. The number of covered segmental arteries was 6 (4–13). Two endoleaks were observed, one type 1b, and one type II. The delay between TEVAR and open repair was 12±8 weeks. Cerebrospinal fluid drainage was used in 13 cases. Six patients had segmental artery reattachment during surgery. No spinal cord ischemic event was observed. One patient died five weeks after open repair from multiple organ failure. During the 32 months of follow-up, no aortic-related deaths occurred. No new aortic procedure was needed. The type 1b endoleak resolved during open repair, and the type II TAAA resolved spontaneously. The mean maximal thoracic aortic diameter significantly decreased to 49±8 mm (p Conclusion Staged hybrid repair of type II TAAA appears to be efficient with low morbidity and mortality rates. This technique could improve postoperative outcomes after open repair and TEVAR might have a role in spinal cord ischemic preconditioning.