Staged hybrid approach using proximal thoracic endovascular aneurysm repair and distal open repair for the treatment of extensive thoracoabdominal aortic aneurysms.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: <2008-> : New York, NY : Elsevier
      Original Publication: St. Louis, Mo. : Mosby, [c1984-
    • Subject Terms:
      Endovascular Procedures*; Aortic Dissection/*surgery ; Aortic Aneurysm, Thoracic/*surgery ; Blood Vessel Prosthesis Implantation/*methods; Adult ; Aged ; Aortic Dissection/diagnosis ; Aortic Dissection/etiology ; Aortic Aneurysm, Thoracic/diagnosis ; Aortic Aneurysm, Thoracic/etiology ; Cohort Studies ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome ; Young Adult
    • Abstract:
      Objective: Repair of patients with extent I and II thoracoabdominal aortic aneurysms (TAAAs) is associated with significant morbidity and mortality, whereas repair of more distal extent III and IV TAAAs has a lower risk of paraplegia and death. Therefore, we describe an approach using thoracic endovascular aneurysm repair (TEVAR) as the index operation to convert extent I and II TAAAs to extent III and IV TAAAs amenable to subsequent open aortic repair to minimize patient risk.
      Methods: Between July 2007 and March 2012, 10 staged hybrid operations were performed to treat one extent I and nine extent II TAAAs. Aortic aneurysm pathology included five chronic type B dissections, three acute type B dissections, and two penetrating aortic ulcers. Initially, the proximal descending thoracic aorta was repaired with TEVAR for coverage of the most proximal fenestration or penetrating ulcer, with seven elective and three emergent repairs. Interval open distal aortic replacement was performed in a short-term planned setting or for progressive dilation of the distal aortic segment. In the open repair, the proximal end of the graft was sewn directly to the distal end of the TEVAR and outer wall of the aorta.
      Results: Average patient age was 48 years, and 60% were men. Risk factors included hypertension (80%), current tobacco use (50%), and Marfan syndrome (30%). Complications after TEVAR included type IA (n=1) and type II (n=3) endoleaks, pleural effusions (n=3), and acute kidney injury (n=1). Three patients required endovascular reinterventions. In patients with dissection, persistent filling of the false lumen was common and associated with distal thoracic aortic dilation. Complications of open repair included acute kidney injury in two patients, but no cardiac, pulmonary, or neurologic morbidity. Median time between TEVAR and open repair was 14 weeks. Most importantly, no deaths or neurologic deficits occurred after either procedure during a median follow-up of 35 weeks.
      Conclusions: A staged hybrid approach to extensive TAAAs combining proximal TEVAR, followed by interval open distal TAAA repair, is safe and appears to be an effective alternative to traditional open repair. This approach may decrease the significant morbidity associated with single-stage open extent I and II TAAA repairs and may be applicable to multiple TAAA etiologies.
      (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
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    • Grant Information:
      T32 HL007849 United States HL NHLBI NIH HHS
    • Publication Date:
      Date Created: 20120727 Date Completed: 20130311 Latest Revision: 20221207
    • Publication Date:
      20231215
    • Accession Number:
      PMC3508078
    • Accession Number:
      10.1016/j.jvs.2012.05.091
    • Accession Number:
      22832268