Editor's note:

In response to the Belt and Road Initiative, and with the aim of sharing expertise and addressing shared health challenges, our hospital has launched the Overseas Promotion Program for New Medical Technologies. If you are interested in any of the medical technologies covered under this program, please feel free to contact the International Cooperation Office at faowch@163.com.

Precision Therapy for Aortic Pathologies: Advanced Hybrid/Total Endovascular Solutions

Thoracic and abdominal aortic diseases, including aortic dissection, aneurysm, penetrating aortic ulcer and intramural hematoma, represent a group of critical and life-threatening cardiovascular conditions. While traditional open surgery remains a definitive treatment, it is highly invasive and carries substantial risks of morbidity, mortality, and prolonged recovery.

To address these challenges, our team led by Prof. Jia Hu at West China Hospital has pioneered a series of hybrid and total endovascular innovations for complex aortic pathologies. In aortic arch repair, we have achieved total endovascular repair using in-vitro fenestration, in-situ fenestration, and physician-modified or custom-made stent grafts. For high-risk patients with complex anatomy, we employed the Type IV hybrid technique, which avoids sternotomy and cardiopulmonary bypass while ensuring safe and effective vessels reconstruction. The PETTICOAT (provisional extension to induce complete attachment)-assisted two-stage retrograde hybrid arch repair technique was used for Type A aortic dissection with malperfusion syndrome. For thoracoabdominal aortic pathologies, we employ hybrid repair combining abdominal aortic replacement with visceral branches debranching and endovascular repair, thereby avoiding cardiopulmonary bypass and thoracotomy in conventional open surgery. For total endovascular repair, we routinely use 3D printing–assisted in-vitro fenestration and have explored simplified innovative technique via Extended Branched PETTICOAT, which is an innovative solution that combines a bare stent for distal landing in the infrarenal aorta, standard infrarenal endovascular aortic repair, and branch stents to preserve visceral perfusion in the presence of distal tears.

To date, more than 500 patients have benefited from these technique innovations at our center, with 100% technical success, zero perioperative mortality or major adverse events, and significantly faster postoperative recovery.

Building on extensive clinical experience and collaboration with multiple regional hospitals across China, this program has developed a scalable, resource-efficient model for the management of complex aortic diseases. With minimal infrastructure requirements, the program enables local cardiovascular centers with existing endovascular capabilities to deliver advanced aortic repair safely and effectively. Standardized training, proctoring and digital case-sharing platforms ensure procedural quality and sustainability.

Cardiovascular disease remains the leading cause of death in many “Belt and Road” countries, where resources for complex, high-risk open-heart surgery remain limited. Given the increasing global burden of aortic disease, these minimally invasive solutions may offer a viable pathway for capacity building and knowledge transfer, helping local centers strengthen diagnostic, procedural, and postoperative care capabilities. We are actively exploring opportunities to share technical experience, establish training platforms and collaborate with partner institutions along the “Belt and Road”, fostering the establishment of regional centers of excellence in aortic therapy.

Our program has been showcased through more than 30 international presentations, live surgical demonstrations and peer-reviewed publications, reflecting the growing international recognition and clinical maturity of the West China Hospital experience. Through ongoing clinical innovation, evidence accumulation and international academic exchange, this program embodies our commitment to advancing safer, more accessible and precision-driven management of aortic pathologies worldwide.