{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:19:56Z","timestamp":1760235596739,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T00:00:00Z","timestamp":1630281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Aortic arch disease is still a high-risk surgical challenge despite major advances both in surgical and anesthesiological management. A combined surgical and endovascular approach has been proposed for aortic arch disease treatment to avoid hypothermia and circulatory arrest in high-risk patients. Materials and Methods: Between June 2004 and June 2021, 112 patients were referred to our department for aortic arch surgery; 38 (33.9%) patients underwent supra-aortic debranching and endovascular treatment. Of these, 21 (55%) patients underwent type I aortic arch hybrid debranching procedure and in 17 (45%) patients a type II aortic arch hybrid debranching procedure was performed. None of the patients were emergent. Results: No intra-operative deaths were recorded. In the type I aortic arch hybrid debranching patients\u2019 group, one patient died at home waiting the endovascular step, one developed ascending aortic dissection and another one developed a pseudoaneurysm at the site of the debranching at follow-up. In the type II aortic arch hybrid debranching patients\u2019 group, left carotid artery branch closure was detected at follow-up in one patient. Thirty day\/in-hospital rates of adverse neurological events for both the surgical and endovascular procedures were 3% for minor stroke, with no permanent neurological deficit and 0% for permanent paraplegia\/paraparesis. In 100% of the cases, the endovascular step succeeded and the type Ia endoleak rate was 0%. Conclusions: Hybrid arch surgery is a valuable option for aortic arch aneurysm treatment in patients with high surgical risk. The choice of aortic arch debranching between type I or type II is crucial and depends on anatomic and clinical patient characteristics. Further larger scale studies are needed to better define the advantages of these techniques.<\/jats:p>","DOI":"10.3390\/medicina57090909","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T22:49:51Z","timestamp":1630363791000},"page":"909","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hybrid Surgery to Manage Aortic Arch Pathology"],"prefix":"10.3390","volume":"57","author":[{"given":"Guido","family":"Gelpi","sequence":"first","affiliation":[{"name":"ASST Fatebenefratelli Sacco\u2014Cardiovascular Surgery Department, 20100 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Romagnoni","sequence":"additional","affiliation":[{"name":"ASST Fatebenefratelli Sacco\u2014Cardiovascular Surgery Department, 20100 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Epifani","sequence":"additional","affiliation":[{"name":"ASST Fatebenefratelli Sacco\u2014Cardiovascular Surgery Department, 20100 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Contino","sequence":"additional","affiliation":[{"name":"ASST Fatebenefratelli Sacco\u2014Cardiovascular Surgery Department, 20100 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Antona","sequence":"additional","affiliation":[{"name":"ASST Fatebenefratelli Sacco\u2014Cardiovascular Surgery Department, 20100 Milano, Italy"},{"name":"Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Universit\u00e0 degli Studi di Milano, 20100 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"key":"ref_1","first-page":"531","article-title":"Aortic arch repair today: Open repair is best for most arch lesions","volume":"56","author":"Coselli","year":"2015","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_2","first-page":"261","article-title":"A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion","volume":"2","author":"Tian","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"II62e71","DOI":"10.1177\/15266028040110S609","article-title":"Endografting of the aortic arch","volume":"11","author":"Ishimaru","year":"2004","journal-title":"J. Endovasc. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.1016\/j.jtcvs.2010.07.031","article-title":"Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution","volume":"140","author":"Bavaria","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.ejvs.2010.08.017","article-title":"Hybrid Aortic Arch Repair Procedure: Reinforcement of the Aorta for a Safe and Durable Landing Zone","volume":"40","author":"Gelpi","year":"2010","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.athoracsur.2006.07.001","article-title":"Hybrid Technique for Total Arch Repair: Aortic Neck Reshaping for Endovascular-Graft Fixation","volume":"83","author":"Antona","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0003-4975(01)03236-2","article-title":"Yearly rupture or dissection rates for thoracic aortic aneurysms: Simple prediction based on size","volume":"73","author":"Davies","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jvs.2009.09.043","article-title":"Hybrid thoracic endovascular aortic repair: Pushing the envelope","volume":"51","author":"Younes","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"ESC committee for practice guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_10","first-page":"657","article-title":"Successful resection of fusiform aneurysm of aortic arch with re-placement by homograft","volume":"105","author":"Crawford","year":"1957","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/S0022-5223(19)39653-9","article-title":"Prosthetic replacement of the aortic arch","volume":"70","author":"Griepp","year":"1975","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1055\/s-2007-1020290","article-title":"Extensive aortic replacement using \u201celephant trunk\u201d prosthesis","volume":"31","author":"Borst","year":"1983","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_13","first-page":"353","article-title":"Total arch replacement with separated graft technique and selective antegrade cerebral perfusion","volume":"2","author":"Kazui","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.ejcts.2006.12.032","article-title":"Antegrade selective cerebral perfusion in thoracic aorta surgery: Safety of moderate hypothermia","volume":"31","author":"Pacini","year":"2007","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ejvs.2018.09.016","article-title":"Choice-Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)","volume":"57","author":"Czerny","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_16","first-page":"188","article-title":"New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft","volume":"94","author":"Kato","year":"1996","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/S0022-5223(96)70157-5","article-title":"Stented elephant trunk procedure for an extensive aneurysm involving distal aortic arch and descending aorta","volume":"112","author":"Suto","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/S0003-4975(02)03745-1","article-title":"Combined Surgical and Endovascular Treatment of Acute Aortic Dissection Type A: Preliminary Results","volume":"74","author":"Fleck","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S1010-7940(02)00563-8","article-title":"Endoluminal stent graft repair for acute and chronic type B aortic dissection and atherosclerotic aneurysm of the thoracic aorta: An interdisciplinary task","volume":"22","author":"Herold","year":"2002","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/bjs.10713","article-title":"Hybrid and total a\u00ecendovascular repair of the aortic arch","volume":"105","author":"Rudarakanchana","year":"2018","journal-title":"J. Br. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.hlc.2018.03.016","article-title":"Aortic Arch Reconstruction: Are Hybrid Debranching Procedures a Good Choice?","volume":"27","author":"Papakonstantinou","year":"2018","journal-title":"Heart Lung Circ."},{"key":"ref_22","first-page":"93","article-title":"Clinical experience of the use of self-fixing synthetic prostheses for remote endo-prosthetics of the thoracic and the abdominal aorta and iliac arteries through the femoral artery and as intraoperative endo-prosthesis for aorta reconstruction","volume":"33","author":"Volodos","year":"1991","journal-title":"VASA Suppl."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1177\/15266028020090S216","article-title":"First International Summit on Thoracic Aortic Endografting: Roundtable on thoracic aortic dissection as an indication for endografting","volume":"9","author":"Mitchell","year":"2002","journal-title":"J. Endovasc. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/1089253216659701","article-title":"Hybrid Techniques for Aortic Arch Aneurysm Repair","volume":"20","author":"Sultan","year":"2016","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/BF02015271","article-title":"Transfemoral Intraluminal Graft Implantation for Abdominal Aortic Aneurysms","volume":"5","author":"Parodi","year":"1991","journal-title":"Ann. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1093\/ejcts\/ezx493","article-title":"Orthotopic branched endovascular aortic arch repair in patients who cannot undergo classical surgery","volume":"53","author":"Czerny","year":"2018","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"147e51","DOI":"10.1016\/j.ejvs.2005.02.049","article-title":"Experiences of intentional carotid stenting in endovascular repair of aortic arch aneurysmsetwo case reports","volume":"30","author":"Larzon","year":"2005","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Inoue, K., Hosokawa, H., Iwase, T., Sato, M., Yoshida, Y., Ueno, K., Tsubokawa, A., Tanaka, T., Tamaki, S., and Suzuki, T. (1999). Aortic arch reconstruction by transluminally placed endovascular branched stent graft. Circulation, 100.","DOI":"10.1161\/circ.100.suppl_2.Ii-316"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.ejvs.2016.10.001","article-title":"A comprehensive review of In Situ fenestrationof aortic endografts","volume":"52","author":"Glorion","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"24S","DOI":"10.1016\/j.jvs.2008.08.037","article-title":"Thoracic endovascular aneurysm repair in Japan: Experience with fenestrated stent grafts in the treatment of distal arch aneurysms","volume":"48","author":"Kawaguchi","year":"2008","journal-title":"J. Vasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.avsg.2012.05.014","article-title":"Endovascular Chimney Technique of Aortic Arch Pathologies: A Systematic Review","volume":"26","author":"Yang","year":"2012","journal-title":"Ann. Vasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jvs.2013.03.043","article-title":"Thoracic endovascular aortic repair with the chimney graft technique","volume":"58","author":"Hogendoorn","year":"2013","journal-title":"J. Vasc. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/909\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:55:48Z","timestamp":1760165748000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/909"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,30]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["medicina57090909"],"URL":"https:\/\/doi.org\/10.3390\/medicina57090909","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2021,8,30]]}}}