Artikel
Total aortic replacement for extensive aneurysmal disease by staged hybrid procedure using E-vita open followed by percutaneous endovascular interventions
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Autoren
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Philipp Kolat
- Universitätsklinik Regensburg, Herz-, Thorax- & herznahe Gefäßchirurgie, Regensburg
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Reinhard Kobuch
- Universitätsklinik Regensburg, Herz-, Thorax- & herznahe Gefäßchirurgie, Regensburg
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Stefan Hirt
- Universitätsklinik Regensburg, Herz-, Thorax- & herznahe Gefäßchirurgie, Regensburg
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Markus Janotta
- Universitätsklinik Regensburg, Herz-, Thorax- & herznahe Gefäßchirurgie, Regensburg
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Piotr Kasprzak
- Universitätsklinik Regensburg, Herz-, Thorax- & herznahe Gefäßchirurgie, Regensburg
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Christof Schmid
- Universitätsklinik Regensburg, Herz-, Thorax- & herznahe Gefäßchirurgie, Regensburg
| Veröffentlicht: | 20. Mai 2011 |
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Gliederung
Text
Introduction: Patients with extensive aortic aneurysms involving the ascending aorta, aortic arch, descending and abdominal aorta require demanding operative strategies. Several methods are available. We report on a novel hybrid procedure combining proximal frozen elephant trunk technique with staged distal percutaneous endovascular interventions.
Materials and methods: Between September 2008 and June 2010 four patients with extensive aneurysmal disease were operated. The first procedure comprised replacement of ascending aorta, aortic arch and proximal descending aorta with the frozen elephant trunk technique (E-vita open).
The second procedure (mean after 153 days) included percutaneous placement of multiple, custom-made endografts in the distal descending and abdominal aorta. In 3 patients multi-branched prosthesis were used, in one patient a fenestrated endograft was implanted. An additional distal extension with aorto-biiliac endografts was necessary in 2 patients.
Results: Overall in-hospital mortality was 0%.No ischemic spinal cord injury or renal failure occured. One patient required re-sternotomie for bleeding. Mean length of hospital-stay was 22.3 days. Postoperative and follow-up CT-scans showed complete exclusion of aneurysms without endoleaks. All patients are well during follow-up (mean 3 months).
Conclusion: A two-staged hybrid procedure for extensive aneurysmal disease is feasible, the invasiveness acceptable, the treatment option for selected patients promising.
