101
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Patel HJ, Upchurch GR, Eliason JL, Criado E, Rectenwald J, Williams DM, Deeb GM. Hybrid Debranching With Endovascular Repair for Thoracoabdominal Aneurysms: A Comparison With Open Repair. Ann Thorac Surg 2010; 89:1475-81. [DOI: 10.1016/j.athoracsur.2010.01.062] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 01/25/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
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102
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Choong AMTL, Clough RE, Bicknell C, Warren O, Hamady M, Jenkins MP, Cheshire NJW. Recent advances in thoraco-abdominal aortic aneurysm repair. Surgeon 2010; 8:28-38. [PMID: 20222400 DOI: 10.1016/j.surge.2009.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thoraco-abdominal aortic aneurysm repair remains a formidable challenge to vascular surgeons. The traditional repair of thoraco-laparotomy with aortic cross-clamping is associated with a high morbidity and mortality despite significant advances in perioperative critical care, anaesthetic and surgical techniques. The advent of the endovascular revolution has shown a marked paradigm in the approach to all aneurysm repairs. As a logical progression from the open repair, the St Mary's visceral hybrid repair combines traditional open techniques (retrograde visceral and renal revascularisation via mid-line laparotomy) with endovascular stent grafting, thereby avoiding the need for thoracotomy and aortic cross-clamping. In specialist centres, the results have been encouraging and easily comparable to the open repair. The technique has been used in several centres around the world and represents a robust, transferrable method of repairing thoraco-abdominal aortic aneurysms. Stent-grafting technologies have reached a point of sophistication that wholly endovascular methods of repairing thoraco-abdominal aortic aneurysms are being performed in several centres around the world. Although these stent grafts have to be customised to the individual patient and are only suitable for certain types of aneurysmal anatomies, they represent the future of thoraco-abdominal aortic aneurysm repair. We review the history of thoraco-abdominal aortic aneurysm repair, the exciting advances in their treatment and discuss our approach to the management of thoraco-abdominal aortic aneurysms in the 21st century.
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Affiliation(s)
- A M T L Choong
- Department of Biosurgery and Surgical Technology, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College London, UK.
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103
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Heyer K, Tang GL, Resnick SA, Eskandari MK. Hybrid thoracoabdominal aortic aneurysm repair: visceral revascularization combined with endovascular abdominal and thoracic aneurysm repair. J Vasc Interv Radiol 2010; 21:735-7. [PMID: 20304679 DOI: 10.1016/j.jvir.2010.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 11/09/2009] [Accepted: 01/19/2010] [Indexed: 11/18/2022] Open
Abstract
Hybrid approaches for the treatment of thoracoabdominal aortic aneurysms (TAAAs) by using a combination of visceral revascularization followed by thoracic endovascular aneurysm repair (EVAR) have been reported with acceptable results. The authors present a case that required the addition of a bifurcated infrarenal EVAR to completely exclude a type III TAAA.
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Affiliation(s)
- Kamaldeep Heyer
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Galter 10-105, Chicago, IL 60611, USA
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104
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Alonso Pérez M, Llaneza Coto J, Camblor Santervás L, García de la Torre A, Valle González A, Domínguez Folgado R, Gutiérrez Julián J. Experiencia preliminar con cirugía híbrida en el tratamiento de los aneurismas toracoabdominales. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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105
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Hansen P, Richards J, Tambyraja A, Khan L, Chalmers R. Natural History of Thoraco-abdominal Aneurysm in High-Risk Patients. Eur J Vasc Endovasc Surg 2010; 39:266-70. [DOI: 10.1016/j.ejvs.2009.12.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 12/19/2009] [Indexed: 10/20/2022]
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106
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Patterson BO, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM. Importance of Aortic Morphology in Planning Aortic Interventions. J Endovasc Ther 2010; 17:73-7. [DOI: 10.1583/09-2967c.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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107
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Endovascular Repair of Thoracoabdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2010; 39:171-8. [DOI: 10.1016/j.ejvs.2009.11.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/07/2009] [Indexed: 11/21/2022]
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108
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Kabbani LS, Criado E, Upchurch GR, Patel HJ, Eliason JL, Rectenwald J, Berguer R. Hybrid Repair of Aortic Aneurysms Involving the Visceral and Renal Vessels. Ann Vasc Surg 2010; 24:219-24. [DOI: 10.1016/j.avsg.2009.08.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 07/21/2009] [Accepted: 08/18/2009] [Indexed: 11/17/2022]
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109
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Combined Open and Endovascular Treatment of Thoracoabdominal Aneurysms and Secondary Expanding Aortic Dissections: Early and Mid-Term Results From a Single-Center Series. Ann Vasc Surg 2010; 24:167-77. [DOI: 10.1016/j.avsg.2009.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 09/22/2009] [Accepted: 10/07/2009] [Indexed: 11/23/2022]
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110
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Younes HK, Davies MG, Bismuth J, Naoum JJ, Peden EK, Reardon MJ, Lumsden AB. Hybrid thoracic endovascular aortic repair: Pushing the envelope. J Vasc Surg 2010; 51:259-66. [PMID: 19954918 DOI: 10.1016/j.jvs.2009.09.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 09/16/2009] [Accepted: 09/19/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Houssam K Younes
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Tex 77030, USA
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111
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Muehling BM, Bischoff G, Schelzig H, Sunder-Plassmann L, Orend K. Hybrid Procedures for Complex Thoracoabdominal Aortic Aneurysms: Early Results and Secondary Interventions. Vasc Endovascular Surg 2009; 44:110-5. [DOI: 10.1177/1538574409347390] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Hybrid procedures for thoracoabdominal aortic aneurysms (TAAA) have been previously described as an attractive alternative to open reconstruction. Patients and Methods: Between 1999 and 2009, 16 patients with a median age of 67years underwent hybrid repair of a TAAA (Crawford type I: 3, type II: 3, type III: 1, and type IV: 9). In 94%, 3 and more severe comorbidities were present, with previous aortic surgery in 56% of the patients; elective/urgent repair was done in 10 and emergent surgery in 6 patients. Results: Primary technical success was 100%, with 31 vessels grafted. Elective/urgent mortality was 20% (2 of 10) and emergent mortality 50% (3 of 6). During follow-up time (median: 12 months) 2 patients died and 2 patients had to undergo secondary interventions. Conclusion: In high-risk patients especially after prior aortic surgery hybrid repair of TAAA is feasible. However, due to high mortality rates especially in the emergent situation this procedure should be reserved only for decidedly selected patients.
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Affiliation(s)
- Bernd M. Muehling
- Department of Thoracic and Vascular Surgery, University of Ulm, Germany,
| | - G. Bischoff
- Department of Thoracic and Vascular Surgery, University of Ulm, Germany
| | - H. Schelzig
- Department of Thoracic and Vascular Surgery, University of Ulm, Germany
| | | | - K.H. Orend
- Department of Thoracic and Vascular Surgery, University of Ulm, Germany
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112
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Abstract
Abdominal aortic aneurysms cause about 6000 deaths per year in England and Wales, predominantly from rupture. Significant progress has been made in recent years in developing minimally invasive, endovascular methods of treatment. This review evaluates the current management options for abdominal aortic aneurysm.
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Affiliation(s)
- N R A Symons
- Department of Vascular Surgery, St Mary's Hospital, Imperial College Academic Health Sciences NHS Trust, London W2 1 NY
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113
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Hybrid repair of complex thoracoabdominal aortic aneurysms using applied endovascular strategies combined with visceral and renal revascularization. J Thorac Cardiovasc Surg 2009; 138:1331-8. [DOI: 10.1016/j.jtcvs.2009.03.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 12/03/2008] [Accepted: 03/21/2009] [Indexed: 11/18/2022]
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114
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Hughes GC, McCann RL. Hybrid Thoracoabdominal Aortic Aneurysm Repair: Concomitant Visceral Revascularization and Endovascular Aneurysm Exclusion. Semin Thorac Cardiovasc Surg 2009; 21:355-62. [DOI: 10.1053/j.semtcvs.2009.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 11/11/2022]
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115
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Richards JMJ, Nimmo AF, Moores CR, Hansen PA, Murie JA, Chalmers RTA. Contemporary results for open repair of suprarenal and type IV thoracoabdominal aortic aneurysms. Br J Surg 2009; 97:45-9. [DOI: 10.1002/bjs.6848] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Endovascular and hybrid procedures are not yet widely established in the management of type IV thoracoabdominal aortic aneurysm (TAAA). Open surgery remains the treatment of choice until the long-term outcomes of these novel techniques are known.
Methods
This study reviewed a 10-year experience of open repair of non-ruptured type IV and suprarenal TAAA. All procedures were performed using a totally abdominal approach with supracoeliac clamping of the aorta.
Results
There were 53 patients (31 men; 58 per cent) of median age 69 (range 54–82) years. Forty-four patients had a type IV TAAA and nine a suprarenal aneurysm. Three patients (6 per cent) died within 30 days and the 12-month mortality rate for patients followed for at least 1 year was 6 per cent (three of 49). Ten patients (19 per cent) had a cardiac complication, 20 (38 percent) a respiratory complication, three (6 percent) required early reoperation, and one patient (2 percent) developed permanent paraplegia. There was one late death resulting from an aneurysm-related complication.
Conclusion
Open repair of suprarenal aneurysms and type IV TAAA may be undertaken using a totally abdominal approach with acceptable levels of morbidity and mortality.
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Affiliation(s)
- J M J Richards
- Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A F Nimmo
- Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - C R Moores
- Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - P A Hansen
- Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J A Murie
- Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R T A Chalmers
- Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
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116
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Drinkwater S, Böckler D, Eckstein H, Cheshire N, Kotelis D, Wolf O, Hamady M, Geisbüsch P, Clark M, Allenberg J, Wolfe J, Gibbs R, Jenkins M. The Visceral Hybrid Repair of Thoraco-abdominal Aortic Aneurysms – A Collaborative Approach. Eur J Vasc Endovasc Surg 2009; 38:578-85. [DOI: 10.1016/j.ejvs.2009.07.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 07/06/2009] [Indexed: 12/01/2022]
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117
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Wang GJ, Szeto WY, Fairman RM, Woo EY, Bavaria JE, Jackson BM. A composite approach to thoracic aortic stent grafting. Vasc Endovascular Surg 2009; 44:36-9. [PMID: 19864350 DOI: 10.1177/1538574409336021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thoracic endovascular aortic repair has become the preferred modality for the treatment of diverse aortic pathologies of the thoracic aorta. This report is the first to describe the use of 2 different devices for successful exclusion of a dissecting thoracic aneurysm.
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Affiliation(s)
- Grace J Wang
- Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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118
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Da Rocha MFM, Miranda S, Adriani D, Urgnani F, Riambau VA, Mulet J. Hybrid procedures for complex aortic pathology: initial experience at a single center. Rev Esp Cardiol 2009; 62:896-902. [PMID: 19706245 DOI: 10.1016/s1885-5857(09)72654-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To review experience at our center with the use of hybrid techniques for treating complex aneurysms of the thoracic aorta. METHODS The medical records of 41 patients (40 male) with complex aortic aneurysms affecting supra-aortic or visceral vessels who underwent hybrid procedures between 1998 and 2007 were reviewed retrospectively. All patients were in American Society of Anesthesiologists category IV. They were divided in two groups: group A comprised 32 patients with aneurysms involving the aortic arch and its branches (2 ascending aorta replacements, 1 arch repair, 13 carotid-carotid bypasses, 12 carotid-subclavian bypasses, and 4 with total arch debranching); and group B comprised 9 patients with thoracoabdominal aneurysms and visceral vessel transpositions (4 partial and 5 total debranching). The mean age in group A was 69.3+/-1.3 (range, 62-73) years and in group B, 71.5+/-5.0 (range, 68-74) years. RESULTS The mean hospital stay was 18+/-7.1 days (range, 5-35) and 12+/-8.2 days (range, 2-15) in groups A and B, respectively. Overall mortality was 12.2% (3.4% and 44.4% in groups A and B, respectively) and neurological morbidity was 3.4% and 11.1% in the two groups, respectively. CONCLUSIONS The results obtained with hybrid treatment of the aortic arch area were comparable with those of conventional surgery. However, thoracoabdominal repair with complete revascularization of the visceral branches was associated with high mortality. Consequently, hybrid treatment is a valid option for high-risk patients who do not require complete revascularization in the visceral area.
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Affiliation(s)
- Marcio F Maciel Da Rocha
- División de Cirugía Vascular, Instituto del Tórax, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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119
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Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know. Eur Radiol 2009; 20:1011-22. [DOI: 10.1007/s00330-009-1603-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 06/26/2009] [Accepted: 08/06/2009] [Indexed: 11/25/2022]
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120
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Monahan TS, Schneider DB. Fenestrated and Branched Stent Grafts for Repair of Complex Aortic Aneurysms. Semin Vasc Surg 2009; 22:132-9. [DOI: 10.1053/j.semvascsurg.2009.07.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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121
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122
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Melissano G, Chiesa R. Hybrid procedures for thoracoabdominal aneurysms. J Endovasc Ther 2009; 16:451-3. [PMID: 19702358 DOI: 10.1583/1545-1550-16.4.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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123
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Bakoyiannis C, Kalles V, Economopoulos K, Georgopoulos S, Tsigris C, Papalambros E. Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms:. J Endovasc Ther 2009; 16:443-50. [DOI: 10.1583/1545-1550-16.4.443] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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124
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Verhoeven E, Tielliu I, Bos W, Zeebregts C. Present and Future of Branched Stent Grafts in Thoraco-abdominal Aortic Aneurysm Repair: A Single-centre Experience. Eur J Vasc Endovasc Surg 2009; 38:155-61. [DOI: 10.1016/j.ejvs.2009.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
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125
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126
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von Meyenfeldt E, Schnater J, Reekers J, Balm R. An Emergency Visceral Hybrid Procedure for Ruptured Thoraco-Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2009; 38:162-8. [DOI: 10.1016/j.ejvs.2009.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 03/07/2009] [Indexed: 11/25/2022]
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127
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Melissano G, Civilini E, Xiaobing L, Chiesa R. Hybrid approach to a complex ruptured dissecting thoracoabdominal aortic aneurysm. J Vasc Surg 2009; 50:428. [PMID: 19631881 DOI: 10.1016/j.jvs.2009.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 01/27/2009] [Accepted: 01/27/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Germano Melissano
- Department of Vascular Surgery, San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy.
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128
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Barnett BP, Qazi U, Perler BA, Malas MB. Novel approach to a type I endoleak following a hybrid repair of an arch aortic aneurysm. Vasc Endovascular Surg 2009; 43:389-92. [PMID: 19628521 DOI: 10.1177/1538574409338329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hybrid surgical and endovascular approaches such as open visceral vessel debranching and subsequent endovascular exclusion of thoracic abdominal aortic aneurysms (TAAA) represents a significant development in treatment of TAAAs. As compared to traditional endovascular aneurysm repair, hybrid repairs commonly have a higher rate of endoleak and other endograft-related complications. In this report, we present a 71 year-old man with significant comorbidities including chronic obstructive pulmonary disease, hypertension and prostate cancer. The patient after undergoing debranching of the thoracic arch followed by endograft repair of an arch aneurysm developed a proximal type I and type II endoleak fed by the previously ligated left subclavian artery. Despite coiling of the left subclavian artery and proximal extension of the endograft, a type I endoleak persisted. Several months after the left subclavian artery was coiled, a catheter was advanced through the coils and beyond the site of ligation directly into the aneurysmal sac. Once in the aneurysmal sac, multiple coils were deployed resulting in successful treatment of the type I endoleak. This report highlights the unique challenges in treating proximal descending thoracic aneurysms and represents the first report of the treatment of a type I endoleak with reaccess through a previously coiled vessel for deployment of embolics directly into the aneurysmal sac.
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Affiliation(s)
- Brad P Barnett
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland 21224, USA
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129
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Is Hybrid Procedure the Best Treatment Option for Thoraco-Abdominal Aortic Aneurysm? Eur J Vasc Endovasc Surg 2009; 38:26-34. [DOI: 10.1016/j.ejvs.2009.03.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 03/24/2009] [Indexed: 11/21/2022]
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130
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Thoracoabdominal aneurysm repair: Hybrid versus open repair. J Vasc Surg 2009; 50:15-22. [DOI: 10.1016/j.jvs.2008.12.051] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 12/04/2008] [Accepted: 12/21/2008] [Indexed: 11/20/2022]
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131
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Aguiar Lucas L, Rodriguez-Lopez JA, Olsen DM, Diethrich EB. Endovascular repair in the thoracic and abdominal aorta: no increased risk of spinal cord ischemia when both territories are treated. J Endovasc Ther 2009; 16:189-96. [PMID: 19456189 DOI: 10.1583/08-2506.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the morbidity associated with thoracic and abdominal aortic repair using endovascular exclusion alone or combined endovascular and open repair. METHODS Between January 1998 and February 2007, 49 patients (36 men; mean age 70 years) underwent treatment for thoracic and abdominal aorta disease with descending thoracic aortic (DTA) stent-graft and abdominal aortic repair. Thirty-nine patients with coexisting thoracic and abdominal pathologies were classified with multilevel aortic disease (MLAD), whereas 10 patients presented with thoracoabdominal aneurysm. Patients were separated into 3 groups: 1: thoracic stent-grafts and open abdominal repair (n = 18), group 2: thoracic and abdominal stent-grafts (n = 21), and group 3: thoracic stent-grafts with visceral artery debranching (n = 10). Prior carotid-subclavian bypass was performed in 3 (6%) patients with a dominant left vertebral artery. RESULTS Stent-graft deployment was technically successful in all cases. Eight (16%) patients underwent emergent thoracic stent-graft placement. In 9 (18%) patients, the left subclavian artery was covered. No incidence of spinal cord ischemia was observed. The 30-day mortality was 4%, and overall mortality was 6% over a mean 33-month follow-up. The endoleak rate was 6% (1 type I, 1 type II, and 1 type III). CONCLUSION Conventional or endovascular abdominal open repair in combination with DTA stent-grafting is feasible and a safe alternative to traditional open repair. Management of MLAD did not show increased incidence of spinal cord ischemia and was associated with fewer complications and deaths than simultaneous or staged open thoracic and abdominal repairs.
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Affiliation(s)
- Leonardo Aguiar Lucas
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute and Hospital, Phoenix, Arizona, USA
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132
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Eagleton MJ, Greenberg RK. Late Complications after Endovascular Thoracoabdominal Aneurysm Repair. Semin Vasc Surg 2009; 22:87-92. [DOI: 10.1053/j.semvascsurg.2009.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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133
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Sobocinski J, Azzaoui R, D’Elia P, Koussa M, Decoene C, Haulon S. Indications et Résultats du Traitement Endovasculaire des Anévrysmes de l’Aorte ThoracoAbdominale. Ing Rech Biomed 2009. [DOI: 10.1016/s1959-0318(09)74606-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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134
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Bicknell C, Riga C, Wolfe J. Prevention of Paraplegia during Thoracoabdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2009; 37:654-60. [DOI: 10.1016/j.ejvs.2009.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 02/21/2009] [Indexed: 10/20/2022]
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135
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Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair. Cardiovasc Intervent Radiol 2009; 32:923-7. [DOI: 10.1007/s00270-009-9602-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 04/09/2009] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
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136
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Stouffer CW, Mansour MA, Ott MM, Hooker RL, Gorsuch JM, Cuff RF, Davis AT. Initial results of a thoracic aortic endovascular program: safer in high-risk patients. Ann Vasc Surg 2009; 23:478-84. [PMID: 19467837 DOI: 10.1016/j.avsg.2009.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 03/16/2009] [Accepted: 03/21/2009] [Indexed: 10/20/2022]
Abstract
Results are presented from our single-institutional experience with thoracic endovascular aortic repair to confirm that it is safe in patients with significant comorbidities. A retrospective review of all patients undergoing endovascular or open thoracic aortic repair at our institution since 2002 was performed. Main outcome measures included clinical presentation, demographics, preoperative risk factors, operative details, and clinical outcomes. The endovascular group included 37 patients (22 males), whereas the open group included 19 patients (eight males). Eight patients per group were treated emergently for trauma or rupture (22% and 42%, respectively; p=0.11). Endovascular patients were significantly older with more comorbid conditions (p<0.05). However, the overall perioperative complication rate was similar in the two groups (32.4% and 31.6%, respectively). Postoperative renal failure occurred only in four open patients (21.1% vs. 0%, p < 0.05). Operative time, ventilator days, and total length of stay were also greater for open patients (p<0.05). There was one death in the endovascular group and three in the open group (2.7% and 15.8%, respectively; p=0.07). Endovascular patients had shorter operative time and length of stay, fewer ventilator days and intensive care unit days, and fewer transfusions. Although the endovascular patients were significantly older with more comorbidities, the complication rate was similar to the open group. Also, there was a trend toward lower mortality in the endovascular group (p=0.07). Endovascular repair is the procedure of choice for treating the descending thoracic aorta in high-risk patients even in the emergent setting.
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Affiliation(s)
- Chadwick W Stouffer
- Michigan State University/Grand Rapids Medical Education and Research Centre/General Surgery Residency, Grand Rapids, MI, USA.
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137
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Slovut DP, Sullivan TM. Combined Endovascular and Open Revascularization. Ann Vasc Surg 2009; 23:414-24. [DOI: 10.1016/j.avsg.2008.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 12/05/2008] [Indexed: 11/29/2022]
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138
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Successful Repair of Thoracoabdominal Aortic Aneurysm Secondary to Chronic Dissection by Hybrid Therapy Comprising Surgical Visceral Reconstruction and Dual Inoue Stent Graft Implantation. Ann Vasc Surg 2009; 23:410.e7-11. [DOI: 10.1016/j.avsg.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 02/29/2008] [Accepted: 03/03/2008] [Indexed: 11/20/2022]
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139
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Quinones-Baldrich W, Jimenez JC, DeRubertis B, Moore WS. Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience. J Vasc Surg 2009; 49:1125-34. [DOI: 10.1016/j.jvs.2008.12.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 11/17/2008] [Accepted: 12/02/2008] [Indexed: 11/27/2022]
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140
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Meyer C, Probst C, Strunk H, Schiller W, Wilhelm K. Second-Generation Amplatzer Vascular Plug (AVP) for the Treatment of Subsequent Subclavian Backflow Type II Endoleak After TEVAR. Cardiovasc Intervent Radiol 2009; 32:1264-7. [PMID: 19280256 DOI: 10.1007/s00270-009-9517-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 12/22/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
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141
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Bell KE, Lopez AC. Hybrid repair of thoracoabdominal aneurysms: a combined endovascular and open approach. JOURNAL OF VASCULAR NURSING 2009; 26:101-8. [PMID: 19022168 DOI: 10.1016/j.jvn.2008.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 09/05/2008] [Accepted: 09/08/2008] [Indexed: 11/27/2022]
Abstract
Thoracic endografting is emerging as an alternative option in the surgical management of patients who have thoracoabdominal aortic aneurysms (TAAA) or aortic dissection. Due to the high morbidity and mortality rates associated with open TAAA repair, vascular surgeons are searching for innovative methods to repair such aneurysms. A combined endovascular and open approach, otherwise known as the hybrid repair, involves aortic "debranching" (renal and mesenteric revascularization) to create a landing zone for the endograft. Although operative mortality with hybrid is equivalent to mortality found with open repair, reported paralysis rates are reduced. Limited data regarding hybrid graft patency and durability are available. Vascular nurses play a vital role in patient education pre and postoperatively; therefore, they should know the risks and benefits associated with both open and hybrid TAAA repair as well as the risk associated with TAAA rupture. Nurses caring for patients after hybrid repair should possess astute assessment skills in monitoring for postoperative complications. Close observation for stroke, paralysis, renal insufficiency/failure, bowel ischemia/dysfunction, lower extremity ischemia and basic hemodynamics is essential for favorable outcomes. Vascular nurses should provide surgery-specific instruction regarding lengths of stay, expected outcomes, activity restrictions, CT-scan follow-up and possible complications after surgery, including warning signs. In the evolving field of endovascular surgery, vascular nurses must remain current on new innovative techniques being used, such as thoracic endografting.
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Affiliation(s)
- Kerry E Bell
- James A. Haley Veterans Administration, Tampa, Florida 33612, USA
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142
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Criado FJ, McKendrick C, Criado FR. Technical Solutions for Common Problems in TEVAR:. J Endovasc Ther 2009; 16 Suppl 1:I63-79. [DOI: 10.1583/08-2620.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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143
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Bicknell C, Cheshire N, Riga C, Bourke P, Wolfe J, Gibbs R, Jenkins M, Hamady M. Treatment of Complex Aneurysmal Disease with Fenestrated and Branched Stent Grafts. Eur J Vasc Endovasc Surg 2009; 37:175-81. [DOI: 10.1016/j.ejvs.2008.11.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 11/06/2008] [Indexed: 10/21/2022]
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144
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Entire Stent Grafting of the Thoracoabdominal Aorta in a Renal Transplant Recipient Subsequent to Extra-Anatomical Bypasses of the Main Abdominal Vessels. Ann Thorac Surg 2009; 87:623-5. [DOI: 10.1016/j.athoracsur.2008.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 04/17/2008] [Accepted: 06/27/2008] [Indexed: 11/22/2022]
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145
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Gawenda M, Libicher M. Commentary: Imaging to Estimate the Safety of Intentional Celiac Trunk Coverage in TEVAR: Multislice CTA Cannot Replace Angiography at Present. J Endovasc Ther 2009; 16:55-8; discussion 58-9. [DOI: 10.1583/08-2549c.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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146
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Wang GJ, Fairman RM, Jackson BM, Szeto WY, Pochettino A, Woo EY. The outcome of thoracic endovascular aortic repair (TEVAR) in patients with renal insufficiency. J Vasc Surg 2009; 49:42-6. [DOI: 10.1016/j.jvs.2008.07.070] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 07/22/2008] [Accepted: 07/23/2008] [Indexed: 11/28/2022]
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147
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Parsa CJ, Hughes GC. Surgical Options to Contend with Thoracic Aortic Pathology. Semin Roentgenol 2009; 44:29-51. [PMID: 19064070 DOI: 10.1053/j.ro.2008.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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148
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Riga C, Bicknell C, Jenkins M, Hamady M. Coil Embolization of an Aneurysmal Type B Dissection Persistent False Lumen after Visceral Hybrid Repair. J Vasc Interv Radiol 2009; 20:130-2. [DOI: 10.1016/j.jvir.2008.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 09/23/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022] Open
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149
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A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach. J Vasc Surg 2008; 48:1593-6. [DOI: 10.1016/j.jvs.2008.06.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 06/20/2008] [Accepted: 06/23/2008] [Indexed: 11/23/2022]
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150
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Mastracci TM, Greenberg RK. Complex aortic disease: Changes in perception, evaluation and management. J Vasc Surg 2008; 48:17S-23S; discussion 23S. [DOI: 10.1016/j.jvs.2008.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 08/26/2008] [Accepted: 09/04/2008] [Indexed: 11/28/2022]
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