Hybrid Aortic Arch Surgery
Using a hybrid endovascular approach, surgeons can repair aneurysms of the aortic arch in a single operation, providing a faster recovery and sparing patients a second major surgery.
The aorta is the largest artery in the human body. It receives blood from the heart and distributes it throughout the body. An aneurysm, a weakening or ballooning of a blood vessel, may occur in any artery in the body, including any part of the aorta. If an aneurysm develops in the aortic arch, the curved portion of the aorta, which supplies blood to the brain and arms, surgery to rebuild the vessel may be needed to prevent a rupture.
Until recently, operations on the aortic arch required two operations, performed six weeks apart. Now, a novel use of endovascular technology allows the two procedures to be combined into a single operation.
According to Allan Stewart, MD, Director, Aortic Surgery Program, the new hybrid procedure combines open surgery with endovascular repair. In this procedure, the physician inserts a catheter through the femoral artery in the groin. He then delivers a stent graft (a mesh-like tube) through the catheter in a collapsed state. The stent graft is positioned at the site of the aneurysm and expanded ('deployed'), replacing and reinforcing the diseased aortic wall and ensuring that blood flows properly through the vessel.
The benefits of this new procedure include greatly reduced risk, a shorter hospital stay, and a more rapid recovery. It also spares patients a second major surgery. "Compared to open surgery, the endovascular approach significantly shortens the length of aortic arch surgery and reduces the adverse effects associated with these operations," says Dr. Stewart. He performs endovascular procedures in a new, state-of-the art hybrid operating room in NewYork-Presbyterian Hospital/Columbia University Medical Center's new heart hospital, which is attached to the main hospital.
Not all aortic arch aneurysms require surgery. Most patients who are evaluated for aneurysms can safely be monitored on a regular basis instead. According to Dr. Stewart, "Most people can tolerate aneurysms of up to five centimeters without any real increased risk of aortic problems. Beyond that size, however, there is an increased risk of tearing." More precise determination is based on the ratio of the normal diameter and the size of the abnormal vessel. Patients should be carefully evaluated to determine whether surgery is needed.
Catheter-based aortic procedures are usually performed under local anesthesia by a multidisciplinary team including vascular surgeons, interventional cardiologists, and cardiac surgeons. This approach is especially beneficial to older patients, who might be ineligible for open surgery due to advanced illness.
Read more about aortic surgery at Columbia.