Tratamiento híbrido de la patología compleja del arco aórtico

Summary. Introduction. The conventional treatment of complex aortic arch pathology requires invasive surgical approaches, with high morbidity and mortality rates. Combining open surgery and endovascular procedures can reduce the degree of surgical invasiveness. Aim. To determine shor- tand medium-term outcomes of hybrid repair of complex aortic arch pathologies by means of a prospective observation-based study. Patients and methods. Of a sample of 71 consecutive patients who underwent endovascular treatment of the thoracic aorta between January 2000 and June 2007, 10 required the use of hybrid techniques. The aortic pathologies that were treated were: three arteriosclerotic aneurysms (30%), three type B dissections (30%), three pseudoaneurysms (30%) and one aberrant right subclavian (10%). In one patient the stent had to be anchored in zone 0 (10%), six in zone 1 (60%) and three in zone 2 (30%). Results. Three patients were treated emergently (30%), initial clinical success being 90% and the total success, 100%. One patient died of pneumonia resulting from mechanical ventilation. Only one cerebrovascular accident (10%) was observed, with full clinical recovery. The patients with pseudoaneurysms and those who required anchoring in zone 1 spent a longer period of time in the Intensive Care Unit and also in the hospital ward. The mean follow-up time of the series was 13.5 months (range: 1-36 months), with survival of the whole series after the immediate post-operative period; there were no recurrences of the pathologies that had been treated in the operations or complications related to the endovascular device. Conclusions. The hybrid treatment of complex aortic arch pathologies does present a small incidence of spinal paralysis and mortality, but short- and medium-term outcomes are optimum. [ANGIOLOGÍA 2008; 60:17-25]