Hybrid Surgical treatment of thoraco-abdominal aneurysm: case report

The conventional surgical treatment of TAAA is complex and is associated with important perioperative mortality and mobidity. There is consensus that endovascular aneurysm repair (EVAR) is the preferred treatment for high-risk patients, but the availability of endovascular-branched grafts are quite limited. As an alternative for such dilema, the hybrid approach came as another possibility for high risk patients where totally endovascular treatment is not feasible and clinical condition for convencional surgery is prohibitive. Thus, the objective of this study is to report our service's experience with the hybrid surgical technique for treatment of this severe condition. Male patient, 73 years old, diagnosed with fusiform aortic aneurysm at the thoracoabdominal transition level, measuring 10.1 x 8.9 cm, associated with a large retroperitoneal hematoma, likely corresponding to an aneurysm rupture. The hybrid strategy was chosen, involving two stages: conventional surgery and endovascular procedures. However, approximately 24 hours after the first surgery the patient had refractory cardiac arrest at intensive care unit. Surgical treatment of thoracoabdominal aneurysm is a complex issue, and the trend over time is tending toward total endovascular treatment, and these devices will undoubtedly evolve and be used more and more in the years to come. However, the hybrid repair will likely remain a standard procedure for a while, until total endovascular procedures become more common and the necessary endovascular materials widely available.