Outcomes After One Stage Versus Two Stage Open Repair of Type II Thoraco-Abdominal Aortic Aneurysms

Abstract

Objective/Background: Sarcopenia is a predictor of mortality in elderly patients. Masseter area (MA) reflects sarcopenia in trauma patients. It was hypothesised that MA and Masseter density (MD) could be evaluated reliably from pre-operative computed tomography angiography (CTA) scans and that they predict post-operative survival in carotid endarterectomy (CEA) patients.Methods: This was an observational registry study. Patients (n = 242) were operated on for asymptomatic stenosis (n = 32; 13.2%), amaurosis fugax (n = 41; 16.9%), transient ischaemic attack (n = 85; 35.1%), or ischaemic stroke (n = 84; 34.7%). Internal carotid artery stenoses were graded angiographically. Intraclass correlation coefficient (ICC) was used to analyse measurement reliability by three independent observers. Cox regression analysis was used to study the effect of MA and MD on survival (hazard ratio [HR]).Results: Median patient age was 71.0 years (interquartile range [IQR] 13.0) and follow up time was 68.5 months (range 3e163 months); at the end of follow up (1 October 2017), 104 (43.0%) patients had died according to the National Population Register. The average MA (MAavg, the mean of left and right MA [median 394.0 mm 2 ; IQR 110.1 mm 2 ]) and MD (MDavg, the mean of left and right MD [median 53.5 HU; IQR 16.5 HU]) could be measured with excellent reliability (ICC > 0.865, p < .001 for all). In multivariable analyses only body surface area (BSA) (p < .001) and dental status were associated with MAavg (p = .021). Increased MAavg predicted lower mortality (HR 0.76, 95% confidence interval [CI] 0.61e0.96; p = .023) independent of age (HR 1.05, 95% CI 1.02e1.07; p = 0.001), female sex, body mass index, renal insufficiency, ipsilateral stenosis, indication category, and presence of teeth. MDavg was not associated with mortality. After further adjustment, BSA (the most significant determinant of MAavg) did not alter the association between MAavg and mortality (0.75, 95% CI 0.58e0.97; p = .031).Conclusion: Average MA but not MD measured from the pre-operative CTA scan provides a reliable estimate of post-operative long-term survival in CEA patients independent of other risk factors, anthropometric measurements, and dental status.

The NephroCheck bedside system for detecting stage 3 acute kidney injury after open thoracoabdominal aortic repair

“…Mortality and morbidity are highly clinically relevant after open and endovascular thoracoabdominal aortic repair 9 , 19 . Consistent with previous trials that investigated larger cohorts 20 , we found a 24% mortality rate among patients undergoing open thoracoabdominal aortic repair.…”

“…The standardized, surgical protocol for open reconstruction of the thoracoabdominal aorta has been previously described in the literature 9 . The protective measures to reduce organ ischemia include distal aortic perfusion with extracorporeal circulation, selective perfusion of the visceral arteries and renal perfusion with maximum 1 L 4 °C Custodiol (Dr. Franz Köhler Chemie, Bensheim, Germany) for both kidneys along with mild systemic hypothermia (32–33 °C).…”

Optimising Aortic Endovascular Repair in Patients with Marfan Syndrome

“…A leading European team in open surgery recently presented outcomes of a two stage open strategy for thoraco-abdominal repair. 31 In two not entirely comparable cohorts, a two stage type 2 open thoraco-abdominal repair compared favourably with a one stage repair in terms of in hospital mortality (0% vs. 22%) and long term survival. Indeed a multistage repair is an attractive strategy in such complex pathologies.…”

Commentary Regarding “Outcomes After One Stage Versus Two Stage Open Repair of Type II Thoraco-abdominal Aortic Aneurysms”

“…In this issue of the European Journal of Vascular and Endovascular Surgery, Gombert et al 1 compare open one stage with two stage repair of type II thoraco-abdominal aortic aneurysm (TAAA). The authors conclude that open two stage repair, if anatomically feasible, demonstrates a lower mortality than and similar complication rates to one stage repair.…”