ORIGINAL ARTICLE  CRITICAL ISSUES ON DEALING WITH CHRONIC POST-DISSECTION ARCH AND THORACOABDOMINAL AORTIC ANEURYSMS Free

The Journal of Cardiovascular Surgery 2020 August;61(4):427-34

DOI: 10.23736/S0021-9509.20.11367-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Outcomes of fenestrated and branched endovascular aortic repair for chronic post-dissection thoracoabdominal aortic aneurysms

Pablo MARQUES DE MARINO, Anas IBRAHEEM, Nargis GAFUR, Eric L. VERHOEVEN, Athanasios KATSARGYRIS ✉

Department of Vascular and Endovascular Surgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany

BACKGROUND: Aneurysmal degeneration after acute dissection occurs in a significant proportion of patients. Fenestrated and branched stent-grafting (F/BEVAR) has been increasingly used to treat these post-dissection thoracoabdominal aortic aneurysms (PD-TAAA). The aim of this study was to report early and mid-term outcomes of F/BEVAR in PD-TAAA.
METHODS: Retrospective single center analysis of a prospectively maintained database including all patients undergoing F/BEVAR for PD-TAAA between October 2010-February 2020.
RESULTS: Fifty-five patients (45 males, mean age 66±10 years) were included. Technical success was achieved in all patients. Thirty-day mortality was two (3.6%) patients. Major perioperative complications were noted in nine (16.4%) patients including five (9.1%) with transient spinal cord ischemia (SCI) and one (1.8%) with permanent paraplegia. Mean follow-up was 24 months (1-76 months). Cumulative survival rates at 12, 24 and 36 months were 87±5.5%, 83.5±6.3% and 72.2±8.1%, respectively. Estimated freedom from reintervention at 12, 24 and 36 months was 82.2±6.7%, 60.1±9.2% and 55.9±9.5%, respectively. Main reasons for reintervention were endoleaks from target vessels and common iliac arteries. Estimated target vessel patency at 12, 24 and 36 months was 97.8±1.2%, 95.4±2.1%, and 94.1±2.4%, respectively. Mean aneurysm sac regression during follow-up was 7.9±7.1 mm, with complete false lumen thrombosis in 80% of patients. No ruptures occurred during follow-up.
CONCLUSIONS: F/BEVAR for PD-TAAA is associated with low perioperative mortality and morbidity in a large volume endovascular center. Mid-term results demonstrate a high rate of aneurysm sac regression. Extended sealing with longer bridging stents for target vessels is recommended.

KEY WORDS: Endovascular procedures; Dissecting aneurysm; Thoracic aortic aneurysm