Hybrid approaches in complex aortic arch pathologies

Aortik ark cerrahisi son yillarda gecmis yillara oranla cok daha dusuk mortalite ve morbidite ile yapilabilir hale gelmistir. Greft interpozisyonunun uygulandigi konvansiyonel acik cerrahi onarim, kesin tedavi sekli olarak dusunulmekle birlikte, ozellikle yuksek riskli hastalarda, hala yuksek cerrahi morbidite ve mortalite oranlarina sahiptir. Aort patolojilerinin endovaskuler onarimi, bircok aort patolojisi icin daha az invazif bir tedavi secenegidir. Endoprotez uygulamasi, aort arki tutulumu durumunda kisitlanabilir cunku, endogreftin yeterli proksimal ve distal fiksasyonu ve anevrizmanin dislanabilmesi icin, arkus damar agizlarindan biri ya da birkacinin kapatilmasi gerekebilir. Debranching baypas uygulamalari, yeterli uzunlukta proksimal ve distal tutunma bolgesi yaratmak amaciyla yapilmaktadir. Sonucta aortik kros klempten, kardiyopulmoner baypastan veya sirkulatuvar arrestten kacinarak, konvansiyonel islemin invazifligini minimalize etmek, ozellikle yuksek riskli hastalarda morbidite ve mortalitenin en aza indirilmesi amaclanir. Bu yazida kompleks aortik ark patolojilerinde hibrid girisimlerin endikasyonlari, uygulama teknikleri, erken ve orta donem sonuclari tartisildi. Ayrica bu konudaki klinik deneyimlerimiz anlatildi. Anah tar soz cuk ler: Anevrizma, diseksiyon/mortalite; sirkulatuvar arrest; endoluminal onarim. In the recent years, aortic arch surgery has reached a level that can be performed with much lower morbidity and mortality rates when compared with the past years. Although the conventional open surgical repair including graft interposition is thought to be the definitive treatment modality, it still has high mortality and morbidity rates, particularly in high-risk patients. Endovascular repair of the aortic pathologies is a less invasive treatment option for many aortic pathologies. Application of an endoprosthesis may be limited in the presence of aortic arch involvement, since it might be necessary to occlude the orifices of one or more branches of the aortic arch for sufficient proximal and distal fixation of the endograft and exclusion of the aneurysm. Debranching bypass procedures are performed to create sufficient length for proximal or distal landing zone. In conclusion, particularly useful in high risk patients, minimizing the invasiveness of the conventional procedure is aimed by avoiding aortic cross-clamping, cardiopulmonary bypass or total circulatory arrest. In this paper; the indications, application techniques, and earlyand mid-term results of the hybrid interventions in complex aortic arch pathologies were discussed. Moreover, our clinical experience was summarized.