Current results of endovascular repair of thoraco-abdominal aneurysms†. Eur J Cardiothorac Surg 2014 Dec;46(6):981-4; discussion 984
Date
03/22/2014Pubmed ID
24652813DOI
10.1093/ejcts/ezu090Scopus ID
2-s2.0-84914138980 (requires institutional sign-in at Scopus site) 24 CitationsAbstract
OBJECTIVES: Fenestrated and branch endografts represent a totally endovascular solution for high-risk patients with atherosclerotic thoraco-abdominal aortic aneurysms (TAAAs). This study reports the early outcome of endovascular TAAA repair.
METHODS: Interrogation of a prospective database of consecutive patients who underwent endovascular repair (EVAR) for TAAA between June 2007 and October 2012.
RESULTS: Sixty-two high-risk patients (55 men; median age 72, range 54-84 years) underwent fenestrated (n = 39) or branch (n = 23) EVAR for non-ruptured TAAA [extent I-III (n = 26) and IV (n = 36)]. Twenty patients had undergone 22 previous aortic procedures. A total of 221 target vessels (coeliac 50, superior mesenteric 61, renal 106, left subclavian 1 and hypogastric 3) were preserved with scallops (n = 17), fenestrations (n = 140) or branches (n = 62) and 201 of these vessels were stent-grafted (coeliac 34, superior mesenteric 58, renal 105, left subclavian 1 and hypogastric 3). The 30-day mortality was 1.6% (n = 1) and one further patient died on postoperative day 62 from respiratory complications. Spinal cord injury (SCI) developed in 5 (8%) patients (3 women and 2 men). Two patients required temporary renal replacement therapy and a further two commenced planned postoperative dialysis.
CONCLUSIONS: In high-risk patients with TAAA, fenestrated and branch EVAR is associated with low early mortality and requirement for renal support, but the risk of SCI is not insignificant despite the use of cerebrospinal fluid drainage and blood pressure manipulation. Our current practice is to stage the repair of extent I-III aneurysms and this has significantly reduced the incidence of SCI.
Author List
Iafrancesco M, Ranasinghe AM, Claridge MW, Mascaro JG, Adam DJAuthor
Jorge G. Mascaro MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Aortic Aneurysm, Thoracic
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Endovascular Procedures
Female
Humans
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Stents
Treatment Outcome
