Our aortic team is unique in treating aneurysms with a hybrid procedure when necessary: making part of the aortic repair with conventional open surgery and the rest with an endovascular approach. The minimally endovascular approach uses small incisions and special tools to reach the aorta.
Not every patient needs a hybrid procedure, but it can provide a less-invasive solution for more complex cases. At the MedStar Heart & Vascular Institute, we complete more of these procedures than any other program in the D.C. area.
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Hybrid Aneurysm Repair for Aortic Arch
After your aorta leaves your heart, it curves back toward your chest and abdomen — an area called the aortic arch. This area is challenging to repair because of the crucial arteries that branch off it to supply the brain and arms with blood.
In the past, open surgery represented the only option for repairing aneurysms in the arch. This involved putting the patient on a heart-lung machine, cooling the body and stopping the normal circulation. But, a hybrid approach offers an alternative, with two main steps:
- Surgery: Our doctors perform open surgery to graft new blood-supplying arteries to the brain and arms, closer to where the aorta leaves the heart.
- Endovascular: A catheter is threaded toward the aneurysm and a stent-graft is positioned over the aneurysm, then released to treat the aneurysm.
Learn more about aortic aneurysms and the parts of the aorta.
Hybrid Aneurysm Repair Benefits
Using a hybrid approach to repair aortic arch aneurysms offers several benefits:
- No heart-lung machine used
- No need to cut into the sensitive aortic arch, resulting in less intense treatment with fewer complications
While we may also use a hybrid approach for aneurysms that cross both the chest and abdomen (thoracoabdominal aneurysms), we can often treat these with a purely endovascular repair. Learn more about the types of aortic aneurysms.
Hybrid Elephant Trunk Procedure
A hybrid procedure can often help patients with extensive aneurysms that involve both the ascending aorta (including the aortic arch) and the descending aorta. The procedure is performed in two stages, usually staggered so the patient can recover in between:
- Surgery: The ascending aorta and arch are replaced with a long-lasting synthetic graft. A second graft is left in the descending aorta but not attached at its far end, leaving it looking like an elephant’s trunk and giving the procedure its name.
- Endovascular: Using a catheter, a stent-graft is placed in the descending aorta, where it joins the earlier elephant trunk graft and completes the repair.
By using an endovascular approach in the second step, the patient avoids a second surgery and a second large incision. Learn more about aortic aneurysms and the parts of the aorta.
Read more about the ways in which MedStar Heart & Vascular Institute cares for your heart.