Hybrid Arch Repair Techniques for Aortic Arch Aneurysms

Patient Selection and Indications

In patients with aortic arch aneurysms who meet criteria for intervention but have high surgical risk, hybrid arch repair combining supra-aortic debranching with thoracic endovascular aortic repair (TEVAR) may be considered as an alternative to open surgical replacement, according to the European Heart Journal and Circulation 1, 2
Hybrid arch repair is specifically indicated for high-risk surgical candidates who meet intervention criteria (arch diameter ≥55 mm) but cannot tolerate conventional open repair due to advanced age, significant comorbidities, or prohibitive operative risk, as recommended by the European Heart Journal and Circulation 1, 2, 3
The American College of Cardiology and European Heart Journal recommend that hybrid arch repair be considered for patients with extensive aneurysmal disease involving both the aortic arch and descending thoracic aorta, where a two-stage approach is generally required, although this specific recommendation is from Praxis Medical Insights, a similar recommendation can be found in 1, 2, 3

For extensive disease involving arch and descending aorta, the two-stage approach is standard, with the first stage creating the landing zone and the second stage completing endovascular repair, as noted in 4
Open surgical replacement remains the gold standard for low-risk patients with isolated arch aneurysms at diameter ≥55 mm, according to the European Heart Journal and Circulation 1, 2, 3
Hybrid techniques offer reduced perioperative morbidity compared to conventional total arch replacement requiring deep hypothermic circulatory arrest, and comparable outcomes to open surgery in appropriately selected high-risk patients, as reported in 1, 2, 3