Outcomes of hybrid endovascular repair of aortic arch pathologies. Safety, durability and patency of hybrid approach for endovascular aortic repair involving the aortic arch

Introduction: Endovascular aortic repair (EVAR) has emerged as the preferred option for high-risk patients. Complex cases often necessitate supra-aortic vessel (SAV) engagement for a stable repair, often using fenestrated/branched thoracic endovascular aortic repair (TEVAR). When these devices are unavailable, a hybrid approach combining surgical debranching of SAV with extra-anatomical bypass offers a viable alternative. This study aimed to evaluate the safety, durability, and patency of the hybrid approach in aortic arch endovascular repairs. Methods: Retrospective and prospective analyses from January 2011 to September 2023, encompassing various aortic pathologies involving the aortic arch, with at least one SAV revascularized via surgical bypass/reimplantation. The primary endpoints were hybrid repair incidence and configurations, technical success, SAV debranching-related complications at 30 days, reinterventions, and follow-up SAV debranching patency. Secondary endpoints included mortality, adverse events, clinical success at 30 days. Results: 67 patients with mean age 71 years, predominantly male, were included. Anatomical subgroups included aortic arch diseases (25%) and thoracic/thoracoabdominal pathologies (75%). Procedural subgroups comprised simple tube TEVAR (67%) and advanced endovascular techniques (33%). Overall, 71 debranching procedures were performed, with left-common-carotid to left-subclavian bypass being the most common (72%). Technical success rate was 94%, with debranching-related complications in 16% and reinterventions in 27% of cases. Secondary endpoints at 30 days showed 10% mortality, 35% major adverse events, and 80% clinical success. Follow-up demonstrated 75% and 85% overall survival rates at 12 and 36 months, respectively, with no aortic-related mortalities. Conclusions: Endovascular hybrid repair is effective for aortic arch pathologies, with high technical success and mid-term debranching patency. Strict follow-up is mandatory for optimal outcomes.