Current results of endovascular repair of thoraco-abdominal aneurysms

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

Mauro Iafrancesco, Aaron M. Ranasinghe, Martin W. Claridge, Jorge G. Mascaro and Donald J. Adam

Reference

Eur J Cardiothorac Surg (2014)

Published

December 2014

Link

http://ejcts.oxfordjournals.org/content/early/2014/03/20/ejcts.ezu090

My Comment

Background

Since several years thoraco-abdominal aortic aneurysms (TAAA) are treated more and more frequently endovascularly (EVAR) using fenestrated and branch endografts technology.

Results

  • Sixty two high-risk patients underwent EVAR (39 fenestrated and 23 branch) for TAAA between 2007 and 2012 at a single center
  • Two hundred twenty one, 140 and 62 vessels were preserved with scallops, fenestrations and branches, respectively. Two hundred one of these vessels were stent-grafted.
  • The 30-day mortality was 1.6% (n=1), one more patients died on postoperative day 62.
  • Spinal cord injury occurred in 5 (8%) patients.
  • Two patients required temporary renal replacement therapy.

My comments

This is one of the largest current single center series on fenestrated and branch EVAR patients. The authors report on a very low 30-day mortality. The risk of spinal cord ischemia, despite the use of cerebrospinal fluid drainage and blood pressure manipulation, is significant and similar to other EVAR series. This report shows that EVAR in patients with TAAA can be performed safely. There is still need to improve the spinal cord perfusion preservation, since most reports on this technology present a risk of spinal cord ischemia of about 10%, which is higher than in patients treated with open surgery. We still need more experience with EVAR in TAAA patients, before we start to expand this technique to post-dissection aneurysms, which are more complicated due to chronic dissection flap. Endovascular technology is expanding, but there are still patients that should undergo open surgery only, like those with connective tissue disease. Centers offering both open and endovascular approach are able to make the best decision on appropriate approach to aortic pathologies. 

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