{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:04:29Z","timestamp":1791518669885,"version":"4.3.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,10,11]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Hybrid debranching repair of pararenal and thoracoabdominal aortic aneurysms was initially designed as a better alternative to standard open repair, addressing the limitations of endovascular repair involving the visceral aorta. We reviewed the collective outcomes of hybrid debranching repairs using extra-anatomic, open surgical debranching of the renal-mesenteric arteries, followed by endovascular aortic stenting.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Data from patients who underwent hybrid repair in 14 North American institutions during 10 years were retrospectively reviewed. Society of Vascular Surgery scores were used to assess comorbidity risk. Early and late outcomes, including mortality, morbidity, reintervention, and patency were analyzed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              A total of 208 patients (118 male; mean age, 71\u00b18 years old) were treated by hybrid repair with extraanatomic reconstruction of 657 renal and mesenteric arteries (mean 3.2 vessels\/patient). Mean aneurysm diameter was 6.6\u00b11.3 cm. Thoracoabdominal aortic aneurysms were identified in 163 (78%) patients and pararenal aneurysms in 45 (22%). A single-stage repair was performed in 92 (44%) patients. The iliac arteries were the most common source of inflow (n=132; 63%), and most (n=150; 72%) had 3 or more bypasses. There were 30 (14%) early deaths, ranging widely across sites (0%\u201321%). A Society of Vascular Surgery comorbidity score &gt;15 was the primary predictor of early mortality (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), whereas mortality was 3% in a score \u22649. Early complications occurred in 140 (73%) patients and included respiratory complications in 45 patients (22%) and spinal cord ischemia in 22 (11%), of whom 10 (45%) fully recovered. At 5 years, survival was 61\u00b15%, primary graft patency was 90\u00b12%, and secondary patency was 93\u00b12%. The most significant predictor of late mortality was renal insufficiency (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Mortality after hybrid repair and visceral debranching is highly variable by center, but strongly affected by preoperative comorbidities and the centers\u2019 experience with the technique. With excellent graft patency at 5 years, the outcomes of hybrid repair done at centers of excellence and in carefully selected patients may be comparable (or better) than traditional open or even totally endovascular approaches. However, in patients already considered as high-risk for surgery, it may not offer better outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.120.045894","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T12:21:07Z","timestamp":1665404467000},"page":"1149-1158","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Results of the North American Complex Abdominal Aortic Debranching (NACAAD) Registry"],"prefix":"10.1161","volume":"146","author":[{"given":"Guillermo A.","family":"Escobar","sequence":"first","affiliation":[{"name":"Emory University, Atlanta, GA (G.A.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8953-7514","authenticated-orcid":true,"given":"Gustavo S.","family":"Oderich","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center at Houston, Houston, TX (G.S.O., E.R.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Farber","sequence":"additional","affiliation":[{"name":"University of North Carolina Health Care, Chapel Hill, NC (M.A.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo R.","family":"de Souza","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil (L.R.d.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Quinones-Baldrich","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles, CA (W.J.Q.-B., J.C.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7639-2416","authenticated-orcid":true,"given":"Himanshu J.","family":"Patel","sequence":"additional","affiliation":[{"name":"University of Michigan Cardiovascular Center, Ann Arbor, MI (H.J.P., J.L.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan L.","family":"Eliason","sequence":"additional","affiliation":[{"name":"University of Michigan Cardiovascular Center, Ann Arbor, MI (H.J.P., J.L.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Gilbert R.","family":"Upchurch","sequence":"additional","affiliation":[{"name":"University of Florida Health, Gainesville, FL (G.R.U.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5251-0633","authenticated-orcid":true,"given":"Carlos","family":"H. Timaran","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern, Dallas, TX (C.H.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"James H.","family":"Black","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bayview Medical Center, Baltimore, MD (J.H.B)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharif H.","family":"Ellozy","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY (S.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward Y.","family":"Woo","sequence":"additional","affiliation":[{"name":"MedStar Health, Washington, DC (E.Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark F.","family":"Fillinger","sequence":"additional","affiliation":[{"name":"Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.F.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Singh","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center, Pittsburgh, PA (M.J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason T.","family":"Lee","sequence":"additional","affiliation":[{"name":"Stanford University Medical Center, Stanford, CA (J.T.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"C. 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Should endovascular approach be considered as the first option for thoraco-abdominal aortic aneurysms? 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