Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: A statewide experience

Rigberg, David A.; McGory, Marcia L.; Zingmond, David S.; Maggard, Melinda A.; Agustin, Michelle; Lawrence, Peter F.; Ko, Clifford Y.

doi:10.1016/j.jvs.2005.10.070

Cited by 293 publications

(202 citation statements)

References 20 publications

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“…A United States state-wide database showed 30 day and 1 year mortality rates after elective TAAA repair of 19% and 31%, respectively. 233 These results indicate that these complex procedures should be performed only in specialized centres. Indeed, adequate staff support and hospital and surgeon volume significantly influence postoperative survival.…”

Section: Managementmentioning

confidence: 98%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

866

236

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Section: Managementmentioning

confidence: 98%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

866

236

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“…70,71 Retrograde revascularization of the visceral vessels (surgical bypass) followed by endovascular exclusion of the aortic aneurysmal site (open debranching technique) has been used, 72 but complication rates remain similar to that of open repair. 73,74 Other options include the chimney and snorkel techniques. These were first described by Greenberg et al, 35 and use commercially available devices by creating parallel channels with covered stents (CVs) to maintain renal and visceral branch perfusion and to intentionally relocate the EVAR seal zone cranially.…”

Section: Hybrid Chimney and Snorkel Repairsmentioning

confidence: 99%

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

et al. 2016

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The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).

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“…3 Statewide audits provide a sobering picture of overall results, with 30-day mortality approaching 20%. 4 Minimally-invasive endovascular repair of TAAA has the potential to reduce mortality and morbidity. [5][6][7][8] In this approach, a cuffed or fenestrated stent-graft forms the trunk and separately inserted covered stents become the branches of a multi-branched thoracoabdominal stent-graft.…”

Section: ¤ ¤mentioning

confidence: 99%

A Standardized Multi-Branched Thoracoabdominal Stent-Graft for Endovascular Aneurysm Repair

Sweet

Hiramoto

Park

et al. 2009

Journal of Endovascular Therapy

130

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¤ ¤Purpose: To assess the feasibility of endovascular thoracoabdominal aortic aneurysm (TAAA) repair using a standard off-the-shelf multi-branched stent-graft. Methods: The aortic anatomy of 66 patients (45 men; mean age 74 years, range 57-87) referred for endovascular repair of TAAA was measured using 3-dimensional reconstructed images from computed tomographic angiograms. In particular, the orientation and longitudinal position of the orifice of each celiac artery, right renal artery, and left renal artery were measured relative to the location of the superior mesenteric artery (SMA) orifice. Based on prior experience, branch insertion with a standard endograft was considered feasible under the following conditions: (1) no more than 4 indispensable (target) arteries to the abdominal viscera, (2) the celiac artery and SMA were 6 to 10 mm in diameter, (3) the renal arteries were 4 to 8 mm in diameter, (4) all target arteries were accessible from a transbrachial approach, (5) the distance between each cuff and the corresponding arterial orifice was #50 mm, and (6) the line between the cuff and the orifice deviated by #45u from the long axis of the aorta. Results: Seven (11%) of 66 patients violated conditions 1 through 4: 2 had target arteries that were either too wide or too narrow, 2 had .4 indispensable visceral or renal branches, and 3 patients had inaccessible upward directed renal artery branches. Three of the remaining 59 patients had renal arteries outside the boundaries defined by conditions 5 and 6 when the hypothetical stent-graft was positioned with its SMA cuff 25 mm proximal to the corresponding SMA orifice. However, if the stent-graft were deployed in a more caudal location, only 1 of these 3 renal arteries would have been out of range. Therefore, 58 (88%) of 66 patients met all the eligibility criteria for repair using the off-the-shelf stentgraft. Conclusion: A standardized, off-the-shelf, multi-branched stent-graft is applicable in 88% of cases of TAAA that would otherwise have been treated using customized stent-grafts. The use of a pre-made stent-graft has the potential to eliminate long manufacturing delays and expand the scope of endovascular repair of TAAA.

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Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: A statewide experience

Cited by 293 publications

References 20 publications

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

A Standardized Multi-Branched Thoracoabdominal Stent-Graft for Endovascular Aneurysm Repair

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