Clinical evaluation of hybrid approaches in treating aortic arch dissection

AIM: To evaluate the clinical follow-up results of treating aortic arch dissection with the hybrid approach of bypass grafting+thoracic endovascular aortic repair(TEVAR).METHODS: Between December 2006 and December 2010,12 patients(ten males and two females,average age 50.3 years) with arch dissection were admitted to our institution and were treated with the hybrid approach of bypass grafting+TEVAR.According to the classification of Criado in 2005,two cases were Z0 dissection,three were Z1 dissection,and seven were Z2 dissection.Comorbidities included aortic valve insufficiency(n=2),coronary artery disease(n=3),hypertension(n=10) and aberrant right subclavian artery(n=1).Mortality and major complication rates and graft patency were evaluated.All patients were followed-up for an average of 28 months(6-48 months) until December 2012.RESULTS: One patient died while waiting for the second-stage TEVAR operation due to aneurysm rupture.One patient converted to total arch replacement+frozen elephant trunk approach because of iatrogenic ascending aorta dissection.During follow-up,type I endoleak occurred and no obvious changes were seen in the following 18 months in one patient and 90% graft stenosis was observed in another patient.Other patients were followed-up with good stent graft shape,patent blood flow and no stent graft stenosis or migration.There were no severe complications of paraplegia or other central nervous system disorders.CONCLUSION: The hybrid approach of bypass grafting+TEVAR extends the application field of endovascular technique to the aortic arch and is proven to be effective in treating arch dissections.This hybrid approach avoids the high risk of deep hyperthermia and cardiac arrest and simplifies the procedure.Individualized hybrid approaches should be adopted for aortic arch dissection.