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1.  Video-atlas of hybrid thoracoabdominal aortic aneurysm repair 
Annals of Cardiothoracic Surgery  2012;1(3):404-405.
Although open surgical repair of thoracoabdominal aortic aneurysm (TAAA) has evolved significantly over the last few decades, technical challenges and current morbidity and mortality of the inclusion technique are still significant, particularly in patients with extensive aneurysms or prior aortic surgery and in poor surgical candidates. Hybrid TAAA repair is an appealing technique and may represent a “bridge” solution as we wait for larger series and reproducible results from the evolving experience with total endovascular TAAA repair with fenestrated and branched endografts.
PMCID: PMC3741765  PMID: 23977527
Thoracoabdominal aortic aneurysm (TAAA); extensive aneurysms; total endovascular TAAA repair
2.  Clinical outcomes of hybrid repair for thoracoabdominal aortic aneurysms 
Annals of Cardiothoracic Surgery  2012;1(3):293-303.
Thoracoabdominal aortic aneurysm (TAAA) hybrid repair consists of aortic visceral branch rerouting followed by TAAA endograft exclusion. This technique has been shown to represent a technically feasible strategy in selected patients.
We analyzed 52 high-risk patients who underwent hybrid TAAA repair between 2001 and 2012 in our centre with a variety of visceral rerouting configurations and of commercially available thoracic endografts. Thirty-seven simultaneous (71.2%) and 15 staged procedures (21.8%) were performed with a four-vessel revascularization in 18 cases (34.6%), a three-vessel revascularization in 11 cases (21.2%) and a two-vessel revascularization in 23 cases (44.2%).
No intraoperative deaths were observed. We recorded a perioperative mortality rate of 13.5% (n=7), including deaths from multiorgan failure (n=2), myocardial infarction (n=2), coagulopathy (n=1), pancreatitis (n=1) and bowel infarction (n=1). Perioperative morbidity rate was 28.8% (n=15), including 2 cases of transient paraparesis and 1 case of permanent paraplegia. Renal failure (n=5), pancreatitis (n=3), respiratory failure (n=3) and dysphagia (n=1) were also observed. At median follow-up of 23.9 months procedure-related mortality rate was 9.6%: two patients died from visceral graft occlusion and three from aortic rupture. There were three endoleaks and one endograft migration, none of which resulted in death. Five patients (9.6%) died as a consequence of unrelated events.
Typical complications of conventional TAAA open surgery have not been eliminated by hybrid repair, and significant mortality and morbidity rates have been recorded. Fate of visceral bypasses and incidence of endoleak and other endograft-related complications needs to be carefully assessed. Hybrid TAAA repair should currently be limited to high-risk surgical patients with unfit anatomy for endovascular repair.
PMCID: PMC3741770  PMID: 23977511
Thoracoabdominal; aorta; aneurysm; hybrid; endovascular
3.  Video-atlas of open thoracoabdominal aortic aneurysm repair 
Annals of Cardiothoracic Surgery  2012;1(3):398-403.
Open surgical repair of thoracoabdominal aortic aneurysms has evolved significantly over the last decades thanks to technical improvements, especially in the area of organ protection. However, despite adjunctive strategies, morbidity and mortality rates are still not negligible. Repair of the thoracoabdominal aorta represents a formidable challenge for surgeons, anesthesiologists and patients alike. While operative repair is generally carried out in specialized institutions, knowledge of the state-of-the-art diagnostic, anesthesiologic, surgical and endovascular aspects will certainly be of great value to all physicians involved in the care of these patients at any level. This “How to” video will explain all of these diagnostic, anesthesiologic and surgical aspects in our daily practice.
PMCID: PMC3741779  PMID: 23977526
Thoracoabdominal aortic aneurysm; diagnosis; open surgical rapair
4.  Emergent Repair of a Complex Dissecting Aneurysm in the Thoracic Aorta 
Texas Heart Institute Journal  2012;39(5):687-691.
Endovascular treatment of complex thoracic pathologic conditions involving the aortic arch can often be appropriate and safe; however, minimally invasive procedures are not always feasible, especially in emergent cases. We report the case of a 78-year-old woman who emergently presented in hemorrhagic shock with a ruptured chronic dissecting aneurysm that involved the aortic arch. Eight years earlier, she had undergone aortic valve replacement and plication of the ascending aorta, which was complicated a day later by Stanford type B dissection, malperfusion, and ischemia that required an axillobifemoral bypass. At the current admission, we successfully treated her surgically through a left thoracotomy, using moderate hypothermic extracorporeal circulation and advanced organ-protection methods. We discuss the surgical indications and our operative strategy in relation to open surgical repair versus endovascular treatment in patients with complex conditions.
PMCID: PMC3461696  PMID: 23109769
Aneurysm, dissecting/radiography/surgery; aortic aneurysm, thoracic/radiography/surgery; aortic diseases/surgery; aortic rupture/surgery; treatment outcome; vascular surgical procedures
5.  Hybrid Repair of Aortic Aneurysms and Dissections 
Texas Heart Institute Journal  2011;38(6):687-690.
PMCID: PMC3233314  PMID: 22199437
Aneurysm, dissecting/surgery; aortic aneurysm, thoracic/surgery; blood vessel prosthesis implantation; endovascular procedures; stents
8.  Hybrid Endovascular and Off-Pump Open Surgical Treatment for Synchronous Aneurysms of the Aortic Arch, Brachiocephalic Trunk, and Abdominal Aorta 
Texas Heart Institute Journal  2004;31(3):283-287.
A 71-year-old patient was admitted for synchronous aneurysms of the aortic arch, brachiocephalic trunk, and juxtarenal abdominal aorta involving the iliac arteries. The patient first underwent open surgical repair of the juxtarenal abdominal aortic aneurysm by means of aorto-bifemoral bypass. Three months later, he underwent off-pump surgical repair of the aneurysm of the brachiocephalic trunk and bypass grafting from the ascending aorta to the brachiocephalic trunk and the left common carotid artery, followed by successful exclusion of the aneurysm of the aortic arch by deployment of a Zenith TX1 custom-made endograft, inserted through a limb of the aorto-bifemoral graft.
Combined endovascular and open surgical treatment is an appealing new alternative to open surgical repair for complex aortic diseases. Debranching of the aortic arch enables endovascular grafting in this area, thereby avoiding cardiopulmonary bypass and circulatory arrest. Staged and simultaneous procedures should be considered for the treatment of complex aortic diseases even in poor-risk patients; however, due to the investigative characteristics of these procedures, patient selection and postoperative follow-up should be carried out with utmost attention.
PMCID: PMC521773  PMID: 15562851
Aortic aneurysm, abdominal/surgery; aortic aneurysm, thoracic/surgery; aortic diseases/therapy; blood vessel prosthesis implantation/methods; brachiocephalic trunk; carotid arteries; stents; vascular surgical procedures/methods
9.  Endovascular Treatment of a Noninfected Anastomotic Juxtarenal Aortic Aneurysm 
Texas Heart Institute Journal  2000;27(4):408-411.
An 82-year-old man underwent an endovascular procedure with a commercially available endovascular graft for an anastomotic juxtarenal abdominal aortic aneurysm. The anastomotic aneurysm, which showed no sign of infection, developed 4 years after implantation of an aortic end-to-end graft for an infrarenal aortic aneurysm.
The aneurysm was diagnosed during routine ultrasonographic follow-up; there was no apparent infection of the graft. Aortography confirmed the diagnosis and also revealed a small pseudoaneurysm at the level of the distal aortic anastomosis. Endovascular surgery was performed in the operating room with the guidance of C-arm fluoroscopy and intravascular ultrasound. Two Vanguard™ Straight Endovascular Aortic Graft Cuffs (26 × 50 mm and 24 × 50 mm) were implanted, successfully excluding both the anastomotic juxtarenal aortic aneurysm and the distal pseudoaneurysm. The renal arteries were preserved and no early or late endoleaks were observed.
The patient was discharged 2 days after the procedure. Sixteen months later, he was alive and well, with no endovascular leakage, no enlargement of the aortic aneurysms, and no sign of infection.
In our opinion, this experience shows that commercially available endovascular grafts may be used successfully to treat anastomotic aortic aneurysms and pseudoaneurysms.
PMCID: PMC101114  PMID: 11198318
Anastomosis, surgical/adverse effects; aortic aneurysm, abdominal/surgery; blood vessel prosthesis; postoperative complications/surgery; reoperation; vascular surgical procedures/methods

Results 1-9 (9)