ABSTRACT
The hybrid arch repair has basically two components, the surgical aortic arch reconstruction with or without repair of the ascending aorta and the endovascular thoracic aortic repair (TEVAR), with different proportions of each component according to the extent of the underlying disease. As for any endovascular stent graft procedure, the proximal and distal landing zone are crucial. Therefore, the main focus of the open surgical component is always a favorable proximal landing zone > 3 cm for the endovascular component of the procedure. With the early hybrid procedures, a classification system for the proximal landing zone was established by Criado et al. in 2002 (Figure 32.1).6 According to underlying aortic disease and its extent, different proximal landing zones for TEVAR can be prepared by intra-or extrathoracic
debranching and varying extent of aortic repair, which is the basis of the hybrid repair classification (Figure 32.2):
●● Type I hybrid repair: The type I hybrid repair (Figure 32.2a) basically represents an aortic arch debranching with a proximal anastomosed multi-branch graft, resulting in a native zone 0 landing zone for subsequent TEVAR. Both the proximal and distal landing zones are favorable for TEVAR. In order to avoid retrograde dissection, a healthy ascending aorta with a diameter < 37 mm is a presumption. The TEVAR component can be performed at the same time, ante-or retrograde, as well as staged.
