Editor's Choice – Outcomes After One Stage Versus Two Stage Open Repair of Type II Thoraco-abdominal Aortic Aneurysms

Abstract

WHAT THIS PAPER ADDS This study confirms that staged open and hybrid surgery of type II thoraco-abdominal aortic aneurysm (TAAA) may be related to favourable results in terms of decreased mortality rates versus one stage type II TAAA open repair. Objective: This study compared the outcomes of open one stage with open two stage repair of type II thoracoabdominal aortic aneurysms (TAAA). Methods: This retrospective study included 94 patients (68 men) with a mean AE SD age of 54.5 AE 14 years who underwent open type II TAAA repair from March 2006 to January 2016. The mean aneurysm diameter was 65 AE 14.4 mm. The median follow up was 42 months (range 12e96). Seventy-six patients received one stage open repair and 18 patients were treated in two steps: 12 received two open procedures (thoracic and abdominal) and six received hybrid repair (one open and one endovascular procedure). This study focused on the comparison of open one stage and open two stage TAAA repair. The median time between the two steps was 31.5 days (range 1e169). Results: In hospital mortality after open one stage repair versus open two stage type II repair was 22.4% versus 0% (odds ratio 7.352, 95% confidence interval [CI] 0.884e959.1]; p ¼ .19). The one year survival rate after one stage repair versus open two stage repair was 74.7% (95% CI 62.7e83.3) versus 90.9% (95% CI 50.8e98.7 [p ¼ .225]). The five year survival rate after one stage repair versus open two stage repair was 53.0% (95% CI 37.2e66.5) versus 90.9% (95% CI 50.8e98.7 [p ¼ .141]). The hazard ratio for survival after one stage repair and after open two stage repair was 4.563 (95% CI 96.9e81.4 [p ¼ .137]). Paraplegia was observed after open one stage repair versus open two stage in 10.5% vs. 8% (p ¼ 1). Acute kidney injury requiring permanent dialysis and myocardial infarction were assessed for after open one stage repair and open two stage and were seen in 3.9% vs. 0% (p ¼ 1) and in 5.3% vs. 0% (p ¼ 1), respectively. Conclusion: Open two stage repair may be recommended as a treatment option for type II TAAAs if anatomically feasible, as it has a lower mortality and similar complication rates to one stage repair.

SLPI - a Biomarker of Acute Kidney Injury after Open and Endovascular Thoracoabdominal Aortic Aneurysm (TAAA) Repair

“…Mortality and morbidity after open and endovascular TAAA Repair remain high 31,32 . In our observational study including TAAA patients, AKI was the most frequent complication after surgery and showed a crucial association with additional severe complications.…”

Staged graft replacement with thoracic endovascular aneurysm repair for an extensive thoracoabdominal aortic aneurysm after total arch replacement: case series

“…Kihara et al performed TEVAR 50 days after the initial Y-grafting with the debranching technique [6]. In a study by Gombert et al both stages were performed with an interval of 14.2 ± 15.3 days (n = 6) [7]. Complications from the primary open surgery in case 1 caused a delay in the secondary TEVAR; however, secondary TEVAR should be performed as soon as possible because of the risk for rupture of the residual aneurysm.…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…Charles et al confirm higher mortality with eGFR loss at long term over a median of 9 years following EVAR, and observed long-term decrease of renal functions in some of the pts [301]. Gombert et al Investigated open repair for type II TAAAs if anatomically feasible [298]. AKI requiring permanent dialysis was seen for after open one stage repair and open two stage in TAA in 3.9% vs. 0% (p = 1), respectively.…”

“…And paraplegia is also a major problem in OR of TAA. Open two stage repair was recommended in a retrospective analysis of 94 pts by Gombert et al as a treatment option for type II TAAAs if anatomically feasible, as it has a lower mortality and similar complication rates to one stage repair [298].…”