Combined Endovascular Treatment of Complex Aortic Pathologies

Abstract

Aim: Multisegmented aortic pathologies present challenging issues independent of the treatment chosen. Whether open or endovascular, staged, or simultaneous, every treatment modality has its own pros and cons. We revealed our patients retrospectively with early and mid-term results who had simultaneous endovascular thoracic and abdominal aortic repair for thoracic aortic pathologies and infrarenal abdominal aortic aneurysm (iAAA) as a single-center experience. Materials and methods: Between January 2016 and January 2021, 16 patients were diagnosed with thoracic aortic pathology, and iAAA was simultaneously repaired in an endovascular manner. All patients were operated on with the same cardiovascular surgeon team. Results: The average age of the patients were 76.9 ± 6.2 (64-86) years. There was no early mortality. The technical success was 100%. 18 thoracic endografts were deployed in 16 patients for thoracic aortic pathologies. Follow up period was 21.85 ± 8.96 months and in the follow-up period, two patients had a secondary intervention. One cardiac and one Covid 19 mortality was detected in the follow-up period. There was no aneurysm-related mortality. The postoperative first-year survival was 84.6±10.0. Conclusion: Simultaneous endovascular solution for complex multisegmented aortic pathologies provides a rapid, less invasive approach with successful early and mid-term morbidity, mortality with short intensive care unit period, and length of hospital stay. A combination of EVAR and TEVAR where anatomic suitability exists is a strong alternative over staged and hybrid therapies. Contrast-induced nephropathy, post-implantation syndrome, and spinal cord ischemia should be carefully monitored with this strategy.