Ten-year Experience with Endovascular Repair of Thoracoabdominal Aortic Aneurysms: Results from 166 Consecutive Patients

Abstract

Objective: To present a 10 year experience with endovascular thoracoabdominal aortic aneurysm (TAAA) repair using fenestrated and branched stent grafts.Materials and methods: Consecutive patients with TAAA treated with fenestrated and branched stent grafts within the period January 2004-December 2013. Data were collected prospectively.Results: 166 patients (125 male, 41 female, mean age 68.8 6 7.6 years) were treated. The mean TAAA diameter was 71 6 9.3 mm. Types of TAAA were: type I, n = 12 (7.2%), type II, n = 50 (30.1%), type III, n = 53 (31.9%), type IV, n = 41 (24.8%), and type V, n = 10 (6%). Fifteen (9%) patients had an acute TAAA (11 contained rupture, 4 symptomatic). One hundred and eight (65%) patients were refused for open surgery earlier.Seventy eight (47%) patients had previously undergone one or more open/ endovascular aortic procedures. Technical success was 95% (157/166). Thirty day operative mortality was 7.8% (13/166), with an in hospital mortality of 9% (15/166). Peri-operative spinal cord ischemia (SCI) was observed in 15 patients (9%), including permanent paraplegia in two (1.2%). Mean follow up was 29.2 6 21 months. During follow up 40 patients died, two of them probably from aneurysm related cause. Re-intervention, mostly by endovascular means, was needed in 40 (24%) patients. Estimated survival at 1, 2, and 5 years was 83% 6 3%, 78% 6 3.5%, and 66.6% 6 6.1%, respectively. Estimated target vessel stent patency at 1, 2, and 5 years was 98% 6 0.6%, 97% 6 0.8%, and 94.2% 6 1.5%, respectively. Estimated freedom from re-intervention at 1 and 3 years was 88.3% 6 2.7%, and 78.4% 6 4.5%, respectively.Conclusions: Endovascular repair of TAAA with fenestrated and branched stent grafts in high volume centers appears safe and effective in the mid-term in a high risk patient cohort. A considerable reintervention rate should be acknowledged, however.

Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure

“…Overall and despite these endoleaks, aneurysm diameter remained stable or decreased in 96% of patients, which compares favorably with the findings described after FEVAR (92e97%). 29,31,32 Moreover, when compared with data from Schanzer et al, 33 sac enlargement was less in the current series. It can be argued that this enlargement was related not only to a lower endoleak incidence (32 vs. 23%), but also to aggressive endoleak treatment based on adherence to a stricter follow up protocol.…”

Short- and Long-term Results of Hybrid Arch and Proximal Descending Thoracic Aortic Repair

“…Our cumulative aortic reintervention estimates to 5 years (36%) are comparable to rates across a broad range of aortic procedures in both the thoracic and abdominal aorta. 27,28 Only 6% of patients required a reintervention to the proximal landing zone during follow-up, demonstrating the durability and long-term success that is achievable if adequate fixation and sealing is obtained at the time of the first procedure. As a general principle, we accept a 2-cm parallel wall landing zone, except in those with significant angulation of the arch where a shorter, lower quality landing zone may be tolerated.…”

Retrograde Target Vessel Catheterization as a Salvage Procedure in Fenestrated/Branched Endografting

“…[1][2][3][4][5][6][7][9][10][11] Recently reported results demonstrate technical success rates as high as 95% for both JAA/ SAA and TAAA. 2,6 The complexity of the aortic anatomy, nevertheless, can result in technical difficulties that impede achieving success as planned. 12 Technical tips and tricks that facilitate target vessel catheterization in cases of difficult anatomy have been described in a previous report.…”

“…[1][2][3][4][5] Reported technical success rates for F/B-EVAR in JAA, SAA, and TAAA are high, with the vast majority of procedures being completed using solely endovascular means. 2,6 However, in a small number of patients, target vessel catheterization proves impossible. In some of these patients, we applied a hybrid technique, retrograde catheterization via laparotomy or retroperitoneal incision, to prevent target vessel loss.…”