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Objective - Open repair of Crawford Extent I/II thoracoabdominal aortic aneurysms(TAAA) are associated with a high rate of major adverse complications. Staged hybrid repair of these extensive TAAAs may reduce this operative risk. In the present study, we review the mid-term outcomes of a previously described technique that combines proximal thoracic endovascular aneurysm repair (TEVAR) followed by staged distal open thoracoabdominal repair for patients with Crawford Extent I/II TAAAs.
Methods - From July 2007 to June 2014, 19 patients with Crawford Extent I(n=1) or Extent II(n=18) TAAAs secondary to chronic aortic dissections underwent a staged hybrid repair. All patients had TEVAR as Stage 1 and open repair as Stage 2, with partial cardio-pulmonary bypass via left femoral arterial and venous cannulation for visceral and lower body perfusion. The open thoracoabdominal graft was anastomosed proximally in end to end fashion with the endograft.
Results - Average patient age was 54 ±17.6 years (14 male). Nine patients had prior open proximal aortic surgery for Type 1 aortic dissections. TEVAR was performed via percutaneous (n=8), femoral cutdown (n=8) or iliac exposure (n=3). The left subclavian artery was covered in 9 patients and re-vascularized in 8 patients by carotid-subclavian bypass (n=7) or laser fenestration (n=1). There were no incidents of death, stroke, or paralysis in this cohort. Following TEVAR, three patients required repeat intervention for endoleak (Type 1A, n=1; Type1B, n =1; Type 2, n=1) prior to open repair. Following open repair, there was a single delayed permanent paralysis. Hospital length of stay was 7±4 days after TEVAR and 9±5 days after open repair. No deaths or neurologic events occurred in the remaining 18 patients over a median 85 week follow up (range 4 weeks to 6.2 years). Importantly, all patients have stable aortic size and remain free of reintervention over the follow-up period.
Conclusions - Staged hybrid repair, combining proximal TEVAR with open distal repair, for extensive TAAAs secondary to chronic dissection is an effective, durable and safe alternative to traditional open repair. This mid-term follow up data suggests that staged repair may reduce perioperative morbidity and mortality in patients with extensive TAAAs.

Outcome of Staged Hybrid Repair of Extent I/II TAAAs

Outcome	Staged Hybrid Repairs (n=19)
Stage 1: TEVAR
Death Stroke / Paraplegia Acute Kidney Injury Type 1 Endoleak Type 2 Endoleak	0 (0%) 0 (0%) 1 (5.2%) 2 (10.5%) 1 (5.2%)
Stage 2: Open Distal Repair
Death Stroke / Paraplegia Acute Kidney Injury (serum Cr > 2) Chronic Renal Failure	0 (0%) 1 (5.2%) 5 (26.3%) 0 (0%)