Endovascular versus conventional open surgical repair for thoracoabdominal aortic aneurysms

Sultan, Sherif; Concannon, Jamie; Veerasingam, Dave; Tawfick, Wael; McHugh, Peter E.; Jordan, Fionnuala; Hynes, Niamh

doi:10.1002/14651858.cd012926.pub2

Cited by 3 publications

(4 citation statements)

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“…The relative availability of non-invasive imaging techniques such as computed tomography angiography and magnetic resonance angiograph has enabled more accurate and rapid diagnosis of VID without the need for invasive angiography [37]. The widespread adoption of endovascular interventions and surgical revascularization has also contributed to the effective and timely treatment of VID, leading to the prevention of more deaths [38][39][40]. In particular, the introduction of endovascular treatment has resulted in lower rates of bowel resection and postoperative mortality compared to traditional open surgery [41].…”

Section: Discussionmentioning

confidence: 99%

The Global Burden of Vascular Intestinal Disorders in 204 Countries and Territories From 1990 to 2019: Global Burden of Diseases Study

Jiang,

Cai,

et al. 2023

Int J Public Health

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Objectives: Assess the prevalence, mortality, and disability-adjusted life years (DALYs) of vascular intestinal disorders (VID) from 1990 to 2019.Methods: This study conducted a secondary data analysis utilizing the Global Burden of Diseases Study 2019. The prevalence, mortality and DALYs of VID were analyzed by sex, age and socio-demographic index (SDI), respectively. Analyses were performed by using R software.Results: Globally, the number of prevalent VID cases increased from 100,158 (95% uncertainty interval: 89,428–114,013) in 1,990–175,740 (157,941–198,969) in 2019. However, the age-standardized rates (ASR) of VID prevalence declined from 2.47 (95% uncertainty interval: 2.24–2.76) per 100,000 population to 2.21 (1.98–2.48) per 100,000 population between 1990 and 2019. Furthermore, the ASR of mortality also decreased from 1990 to 2019. Between 1990 and 2019, the regions with high and high-middle level exhibited the highest diseases burden.Conclusion: Globally, the diseases burden associated with VID demonstrated a decline from 1990 to 2019. However, concerted efforts are still required to enhance measures to combat VID within countries categorized as high and high-middle SDI.

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Section: Discussionmentioning

confidence: 99%

The Global Burden of Vascular Intestinal Disorders in 204 Countries and Territories From 1990 to 2019: Global Burden of Diseases Study

Jiang,

Cai,

et al. 2023

Int J Public Health

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“…Open surgical repair (OSR) shown higher mortality rates, exceeding 50% in ruptured TAAA with high associated morbidity, especially in terms of renal and cardiac complications ( 1 , 2 ). In urgent scenarios, endovascular management of TAAAs may provide an early survival benefit, however comparative studies on OSR and complex endovascular aortic repair are still lacking ( 3 – 6 ). Endovascular aortic repair for urgent cases may be achieved by means of different complex techniques, including parallel grafts, surgeon-modified endografts and off-the-shelf devices ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Mortality in ruptured thoracoabdominal aneurysms (rTAAAs) is high; even when treatment is applied (1,2). Open surgical repair (OSR) shown higher mortality rates, exceeding 50% in ruptured TAAA with high associated morbidity, especially in terms of renal and cardiac complications (1,2). In urgent scenarios, endovascular management of TAAAs may provide an early survival benefit, however comparative studies on OSR and complex endovascular aortic repair are still lacking (3-6).…”

Section: Introductionmentioning

confidence: 99%

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Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

Nana,

Spanos,

Jakimowicz

et al. 2023

Front. Cardiovasc. Med.

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IntroductionEndovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.MethodsProspectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.Results225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I–III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p < .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, p = .04) and MAE (26.0% vs. 43.0%, p = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, p = .9), and SCI (13.3% vs. 18.3%, p = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p = 0.96).ConclusionT-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates.

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