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Ma X, Feng Y, Tardzenyuy MA, Qin B, Zhu Q, Akilu W, Li S, Wei X, Feng X, Cheng C. Debranching abdominal aortic hybrid surgery for aortic diseases involving the visceral arteries. Front Cardiovasc Med 2023; 10:1219788. [PMID: 37522078 PMCID: PMC10374220 DOI: 10.3389/fcvm.2023.1219788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Aortic diseases involving branches of the visceral arteries mainly include thoracoabdominal aortic aneurysm (TAAA), aortic dissection (AD) and abdominal aortic aneurysm (AAA). The focus of treatment is to reconstruct the splanchnic arteries and restore blood supply to the organs. Commonly used methods include thoracoabdominal aortic replacement, thoracic endovascular aortic repair and hybrid approaches. Hybrid surgery for aortic disease involving the visceral arteries, consisting of visceral aortic debranching with retrograde revascularization of the celiac trunk and renal arteries and using stent grafts, has been previously described and may be considered particularly appealing in high-risk patients. This study retrospectively analyzed recorded data of patients and contrasted the outcomes with those of a similar group of patients who underwent conventional open repair surgery. Methods Between 2019 and 2022, 72 patients (52 men) with an average age of 61.57 ± 8.66 years (range, 36-79 years) underwent one-stage debranching abdominal aortic hybrid surgery. These patients, the hybrid group, underwent preoperative Computed Tomographic Angiography (CTA) and had been diagnosed with aortic disease (aneurysm or dissection) involving the visceral arteries and were at high risk for open repair. The criteria used to define these patients as high-risk group who are in the need of hybrid treatment were American Society of Anesthesiologists (ASA) class 3 or 4. In all cases, we accomplished total visceral aortic debranching through a previous visceral artery retrograde revascularization with synthetic grafts (customized Y or four-bifurcated grafts), and aortic endovascular repair with one of two different commercially produced stent grafts (Medtronic® and Lifetech®). In some cases, we chose to connect the renal artery to the artificial vessel with a stent graft (Viabahn) and partly or totally anastomosed. We analyzed the results and compared the outcomes of the hybrid group with those of a similar group of 46 patients (36 men) with an average age 54.15 ± 12.12 years (range, 32-76). These 46 patients, the conventional open group, were selected for having had thoracoabdominal aortic replacement between 2019 and 2022. Results In the hybrid group, 72 visceral bypasses were completed, and endovascular repair was successful in all cases. No intraoperative deaths occurred. Perioperative mortality was 2.78%, and perioperative morbidity was 9.72% (renal insufficiency in 1, unilateral renal infarction in 5, Intestinal ischemia in 1). At 1-month postoperative CTA showed 2 endoleaks, one of which was intervened. At follow-up, there were unplanned reoperation rate of 4.29% and 5 (7.14%) deaths. The remaining patients' grafts were patent at postoperative CTA and no endoleak or stent graft migration had occurred. In the conventional open group, 1 died intraoperatively, 4 died perioperatively, perioperative mortality was 10.87% and complications were respiratory failure in 5, intestinal paralysis/necrosis in 4, renal insufficiency in 17, and paraplegia in 2. At follow-up, 5 (12.20%) patients presented with synthetic grafts hematoma 4 (9.76%) patient died, and 6 (14.63%) patients required unplanned reoperation intervention. Conclusion Hybrid surgery is technically feasible in selected cases. For aortic diseases involving the visceral arteries, the application of hybrid abdominal aorta debranching can simplify the operation process, decrease the risks of mortality and morbidity in high-risk and high-age populations and decrease the incidence of various complications while achieving ideal early clinical efficacy. However, a larger series is required for valid statistical comparisons, and longer follow-ups are necessary to evaluate the long-term efficacy of hybrid surgery.
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Affiliation(s)
- Xiantao Ma
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Feng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mbenkum Achiri Tardzenyuy
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Qin
- Department of Cardiothoracic Surgery, Taikang Tongji (Wuhan) Hospital, Wuhan, China
| | - Qiangzhang Zhu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wajeehullahi Akilu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiliang Li
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Feng
- Division of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Cai Cheng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Mhamdi S, Nakhli M, Chelly M, Chouchene A, Chaouch A, Naija W, Said R. Postendovascular thoracic aortic repair subclavian steal syndrome revealed by severe headache. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S. Mhamdi
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - M.S. Nakhli
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - M. Chelly
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - A. Chouchene
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - A. Chaouch
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - W. Naija
- Department of anesthesia and intensive care, Sahloul Academic Hospital, Sousse, Tunisia
| | - R. Said
- Faculty of Medicine Ibn El Jazzar, University Of Sousse, Tunisia
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Kheirelseid EAH, Gardiner R, Haider SN, Martin Z, Colgan MP, O'Neill SM, Madhavan P. Endovascular repair of thoracoabdominal aortic aneurysm (TAAA): early experience. Ir J Med Sci 2013; 183:153-60. [PMID: 23757213 DOI: 10.1007/s11845-013-0974-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Repair of thoracoabdominal aortic aneurysms (TAAA) represents a considerable technical challenge. Since its first description in 1955, open repair of TAAA has been considered the gold standard of repair. Despite improvements in surgical techniques, spinal cord protection and post-operative critical care support, patients who undergo open repair are faced with a mortality rate of 5-35 %. We report the first Irish experience of endovascular management of TAAAs. RESULTS To date five patients have undergone endovascular repair; four had hybrid repair and one a fenestrated graft. The mean age of the patients was 66.8 ± 3.4 and the mean aneurysm diameter was 6.74 ± 0.6 cm. All patients were ASA III. Two-stage hybrid repair was associated with an increased risk of complications, prolonged intensive care unit and overall hospital stay. One patient died in the perioperative period due to rupture of their aneurysm between the two stages of their hybrid repair. CONCLUSION The role of endovascular techniques in the treatment of TAAA continues to evolve. Hybrid and complete endovascular repairs do not replace conventional repair, but provide an alternative for high-risk patients who might otherwise be denied treatment.
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Affiliation(s)
- E A H Kheirelseid
- Department of Vascular and Endovascular Surgery, St. James's Hospital, St. James's Street, Dublin 8, Ireland,
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Dolinger C, Strider DV. Endovascular interventions for descending thoracic aortic aneurysms: The pivotal role of the clinical nurse in postoperative care. JOURNAL OF VASCULAR NURSING 2011; 28:147-53. [PMID: 21074117 DOI: 10.1016/j.jvn.2010.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 08/31/2010] [Accepted: 08/31/2010] [Indexed: 11/25/2022]
Abstract
Descending thoracic aortic aneurysms (dTAA) comprise 40% of all aneurysms arising from the thoracic aorta. Because rupture of thoracic aneurysms is associated with a 94% mortality rate, timely detection, surveillance and treatment is imperative. Endovascular stent-graft repair of thoracic aneurysms was first performed in 1992 and has become an accepted treatment option for this condition in select candidates. There is an abundance of information for the care of patients after open surgical repair of dTAA. However, still relatively few written guidelines exist in the nursing literature for postoperative care and complications associated with endovascular stent-graft repair. The prevalence of aortic endografting, however, now makes it necessary for nurses to have a solid knowledge base in the operative procedure, complications and postoperative care for this patient population. Ideal candidates for aortic endografting undergo CTA or MRI preoperatively and fit a set of strict anatomic criteria to ensure proper delivery and fixation of the device. The early postoperative care focuses on minimizing pulmonary complications, paraplegia, renal failure and embolic complications such as stroke and limb ischemia through skilled nursing assessment and interventions. Late complications such as stent-graft migration, kinking, stent fracture and endoleak are often without symptoms, making it necessary for patients to be educated about these potential complications and to be encouraged to comply with lifelong follow up. This overview provides a sound cognitive framework for nurses practicing in a vascular surgery milieu.
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Affiliation(s)
- Cami Dolinger
- University of Virginia Health System, Thoracic-Cardiovascular Surgery Division, Charlottesville, VA 22908-1370, USA.
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Robbins DA. Current modalities for abdominal aortic aneurysm repair: Implications for nurses. JOURNAL OF VASCULAR NURSING 2011; 28:136-46. [PMID: 21074116 DOI: 10.1016/j.jvn.2010.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/23/2010] [Accepted: 09/24/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) represent a significant health problem in the United States as more than 1 million people are afflicted and the prevalence is only expected to increase. Given that AAA rupture carries a high mortality rate, there is interest in repairing the aneurysm electively before aneurysm rupture. Two approaches to aneurysm repair are open repair and endovascular repair. However, limited data comparing the outcomes of these different methods exist. OBJECTIVE A systematic review of recent clinical trials was conducted to identify and compare the short- and long-term clinical outcomes between open and endovascular repair. METHODS Prospective, controlled trials published in the last 5 years were acquired using PubMed, Ovid, and Scopus databases. RESULTS Four studies were identified during the search. Study trends suggest a perioperative advantage using endovascular repair. However, this advantage does not appear to be maintained in the long term. CONCLUSIONS Each type of repair carries its own risk profile that is likely influenced by additional factors, such as the patient's age and comorbidities. It is critical that healthcare providers are aware of the risks associated with each approach in order to provide optimal patient care.
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