Surgery of the Aorta is known to be associated with risks due to the enormity/complexity of the surgical repair /blood loss or the patient having multiple other illnesses like heart disease, hypertension, diabetes or kidney failure. This results in prolonged hospital / ICU stay with prolonged recovery time with a higher incidence of complications.
A newer approach to aortic repair is hybrid surgery which is a combination of open surgery and endovascular surgery which while reducing the risks and complications associated with total open repair leads to early recovery and mobility.
Hybrid aortic procedures are indicated in conditions like Aortic dissections, Aortic aneurysm repair, aortic rupture, aortic occlusions and redo aortic surgery. The eligibility of a patient to qualify for a hybrid procedure depends on the nature of the disease and fitness for surgery. They are done for both the thoracic and abdominal aorta. A few examples of Hybrid procedures are as follows
- Cervical bypass (cervical/neck debranching) with thoracic aorta stent graft insertion
This procedure is done in cases where the aorta is diseased very close to the area where the blood vessel of the left arm or left side of the head comes off. Putting a stent graft to treat this area would cut off the blood supply to the arm, hence a bypass is done prior to the stent-graft insertion to preserve blood supply to the arm.
This can be done at a single stage or at multiple sittings within a single admission depending on the patient condition.
Abdominal debranching / bypass with abdominal Aorta Stent graft insertion
This procedure is performed for aortic disease involving the area supply blood to the intestines and kidneys. Aortic disease sometimes makes it difficult and unsafe to operate on the aorta directly. Hence a bypass is done from one of the healthier leg arteries onto the blood vessels supplying the kidneys and intestine followed by a stent-graft insertion. Although abdominal surgery is involved, recovery is faster as there is much less stress, blood loss and morbidity as the aorta is not handled much and the duration of surgery is typically lesser. This can also be done as a single stage or two-stage procedure.