REVIEWS  THORACIC ENDOGRAFTING AND THE MANAGEMENT OF THORACOABDOMINAL ANEURYSMS 

The Journal of Cardiovascular Surgery 2009 August;50(4):439-45

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Endovascular thoracoabdominal aortic aneurysm repair: a literature review of early and mid-term results

D’Elia P., Tyrrell M., Sobocinski J., Azzaoui R., Koussa M., Haulon S.

Department of Vascular Surgery Hôpital Cardiologique, CHRU de Lille, France and King’s College Hospital London, UK

Successful endovascular repair of abdominal aortic aneurysms (AAA) requires undilated proximal (infrarenal neck) and distal landing zones (common or external iliac arteries). A range of approved endografts are available to exclude such aneurysms. Recent multicentric prospective randomized trials have demonstrated a short and midterm decrease in aneurysm-related deaths of the endovascular technique compared to open surgery. These results have induced an overall increase in the rate of endovascular repair of AAA. Patients with more complex aortic aneurysms, involving the visceral vessels (juxta, para and thoraco-abdominal aneurysms (TAAA), have increased perioperative morbidity and mortality after open repair compared to AAA. These patients could potentially benefit from an endovascular approach. Branched and fenestrated endografts have been developed to address this endovascular challenge. This review was carried out on the current literature evaluating these new endovascular complex procedures. Spinal cord ischemia, 30-day mortality and branch patency rates after endovascular exclusion of TAAA ranged from 2.7% to 20%, 0% to 9.1% and 96% to 100% respectively. Mid-term results of endovascular complex aortic repairs are favourable compared to open surgery in high risk patients. Long-term results will be necessary to evaluate specific complications such as migration, material fatigue and component separation that can result in loss of visceral branches.