Learning objectives
The purpose of our educational exhibit is to:
describe the hybrid procedures techniques
highlight the role of diagnostic and interventional radiology in the combined surgical and endovascular approach (hybrid treatment) of thoracic aortic diseases
illustrate the typical pre- and post-operatory imaging findings at Multidetector Computed Tomography (MDCT).
A review of the main pre- and post-operatory imaging findings of 69 patients treated with hybrid approach was performed for this purpose.
Background
Hybrid treatment is a combined surgical/endovascular procedure,
developed thanks to the recent improvement of new imaging,
surgical,
and interventional techniques and materials.
For the management of complex thoracic aortic disease of the ascending aorta,
aortic arch and proximal descending aorta (degenerative aneurysms,
aortic dissection,
penetrating atherosclerotic ulcer or aortic intramural hematoma),
surgery is burdened by high rates of morbidity and mortality and hybrid surgical/radiological procedures are preferable [1-3].
Innovations in thoracic endovascular aortic repair (TEVAR) techniques have enabled its incorporation in open procedures,
resulting in...
Findings and procedure details
Type of surgery techniques preceding endovascular treatment:
Extra-anatomic bypass, [4-5]:
Carotid-subclavian bypass (Fig. 1 andFig. 2)
Carotid-carotid bypass (Fig. 3)
Carotid-carotid + carotid-subclavian bypass (Fig. 4andFig. 5)
LSA Revascularization
LSA is an important source of blood flow to the left arm but it also plays an important role for the collateral pathways to the cerebellum -via the left vertebral artery (VA)- and the spinal cord -via the left VA to the anterior spinal artery,
and collateral perfusion to the left intercostal vessels through the internal...
Conclusion
Hybrid technique is a safe,
effective and less invasive alternative to open surgery,
especially in high-risk patients with multiple comorbidities.
The diagnostic and interventional radiologists play a key role for the treatment planning,
for the selection of the most appropriate hybrid approach and for the imaging follow-up.
Personal information
S.
Seitun Department of Radiology and Interventional Radiology,
IRCCS-University Hospital San Martino-IST,
Genova,
Italy
[email protected]
I.
Budaj Department of Radiology and Interventional Radiology,
IRCCS-University Hospital San Martino-IST,
Genova,
Italy.
M.
Dahmane Department of Radiology and Interventional Radiology,
IRCCS-University Hospital San Martino-IST,
Genova,
Italy.
M.
Castiglione Morelli Department of Radiology and Interventional Radiology,
IRCCS-University Hospital San Martino-IST,
Genova,
Italy.
S.
Boccalini Department of Radiology and Interventional Radiology,
IRCCS-University Hospital San Martino-IST,
Genova,
Italy.
A.
Galletto Department of Radiology and Interventional Radiology,
IRCCS-University Hospital San Martino-IST,
Genova,...
References
Antoniou GA,
El Sakka K,
Hamady M,
Wolfe JH.
Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair.
Eur J Vasc Endovasc Surg.
2010 Jun;39(6):683-90.
Hiratzka LF,
Bakris GL,
Beckman JA,
et al..
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease.
A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines,
American Association for Thoracic Surgery,
American College of Radiology,
American Stroke Association,
Society of Cardiovascular Anesthesiologists,...