Hybrid Repair of Aortic Arch Aneurysms

Isolated aortic arch aneurysms are infrequent. More often aortic arch aneurysms represent distal extension of ascending aortic aneurysms or proximal extension of descending thoracic and thoracoabdominal aneurysms. Conventional open repair has been the time-honored treatment, but carries significant risks of mortality, morbidity, and neurological complications. Hybrid endovascular procedures have emerged as a less-invasive alternative to open conventional repair. These procedures avoid the need for cardiopulmonary bypass, deep hypothermia with circulatory arrest, and antegrade or retrograde cerebral perfusion, potentially decreasing the risk of death or neurological complications. A variety of approaches have been used: hybrid elephant trunk procedures, aorto-brachiocephalic bypasses and extra-anatomic cervical debranching; and more recently the use of "chimney" grafts, fenestrated and branched endografts, usually combined with cervical debranching. This chapter summarizes the evaluation, current techniques, and results of hybrid techniques used to treat aortic arch aneurysms.