Endovascular treatment for thoracoabdominal aneurysms: outcomes and results☆

Abstract

Endovascular treatment of thoracoabdominal aneurysms with selective visceral and renal revascularization is associated with low mortality and can only be effectively performed by a surgeon. High-risk patients and those with acute presentation appear to benefit most from this therapy. Early results up to three years of this therapy are encouraging, but further follow up to validate long-term results is required.

Effect of hybrid endovascular repair for thoraco-abdominal aortic aneurysms on renal function

“…According to our results, mean serum-creatinine concentration increased and creatinine clearance decreased over longterm follow-up that is independent of preoperative renal disease and renal arterial occlusion in seven (12%) of 49 patients and is likely related to the repetitive administration of the contrast agent. Our results, and consecutively the conclusions, are similar to published data by Jacksonville, Pittsburgh, and New York group [2,3,4].…”

“…one of the principle factors in delaying chest-tube removal.' This is also confirmed by Varela et al [4], who observed an increased agreement rate in the chest-tube withdrawal decision-making process with the use of digital devices: this was due, in the authors' reflection, to the fact that an objective quantitative measure of the air leak and, above all, an accurate 'timetrend' analysis of the air leaks 'increased surgeon's confidence in the security of the procedure.' In our own experience (unpublished data) of 39 patients who underwent pulmonary resection where air leaks were accurately analyzed on a daily basis with a new digital system, we routinely adopted a blinded chest-tube withdrawal policy based on the established clinical behavior (empirical) with no influence of instrumental measurement.…”

“…Moreover, Asian people have lower body mass index and all findings reported by Kuratani et al are of little help to clarify conflicting results about nephrotoxicity of intravenous contrast in the follow-up period from other observational studies and clinical trials [3,4].…”

“…Concern regarding the long-term effect on the renal function and the potential nephrotoxicity of intravenous contrast in the follow-up period must be considered [2]. In addition, manipulation of the aorta and visceral arteries may lead to the disruption of lipid-laden plaques and subsequent embolization into the renal vasculature [3,4].…”

Multiple aneurysm repair: hybrid approach to chronic dissection around visceral branches

“…5 Two additional articles containing more than 10 patients with thoracoabdominal aortic aneurysms reported even better results. 14,15 More recently, Kuratani et al reported longterm results of hybrid endovascular repair for thoracoabdominal aortic aneurysms with 2% early mortality and 80% fi ve-year survival. 11 These results were encouraging for the performance of hybrid repair of thoracoabdominal aneurysms.…”