Modified Hybrid Repair with Open Reconstruction of Infrarenal Aortoiliac Segment for Thoracoabdominal Aortic Aneurysms Without Custom Distal Landing Zone: A Single-Center Case Series

Background/Objectives: Inadequate distal landing zones can limit hybrid repair of thoracoabdominal aortic aneurysm (TAAA). We evaluated a modified strategy combining prosthetic distal landing-zone reconstruction, retrograde visceral and renal revascularization, and thoracic stent-graft exclusion. Methods: This retrospective single-center case series included all nine consecutive patients with inadequate native distal landing zones who underwent single-stage modified hybrid repair in 2025. Open aneurysm excision and aortoiliac reconstruction provided the distal sealing segment and inflow for visceral and renal bypasses. The primary outcome was 30-day all-cause mortality. Secondary outcomes included postoperative length of hospital stay, 30-day major complication rate, 30-day paraplegia rate, 1-year reintervention rate, 30-day readmission rate, and technical success rate. Results: Five patients had Crawford extent II aneurysms and four had extent III aneurysms. Technical success was achieved in all nine patients. Median operative time, estimated blood loss, and intensive care unit stay were 724 min, 2500 mL, and 8 days, respectively. Thirty-day all-cause mortality was 0% (0/9). No spinal cord ischemia or mesenteric ischemia occurred within 30 days. Acute kidney injury occurred in six patients (66.7%), including one who received continuous renal replacement therapy. One patient required early covered stent-graft repair of a right iliac anastomotic leak. At a median follow-up of 9 months (IQR, 6–12), all reconstructed visceral and renal bypasses were patent, no new endoleak was detected, and all patients were alive. No additional reintervention was required. Conclusions: Modified hybrid repair with prosthetic distal landing-zone reconstruction was technically feasible in selected TAAA patients with inadequate distal sealing anatomy. Larger studies with longer follow-up are needed to evaluate durability and refine indications.