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

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

DOI: 10.23736/S0021-9509.20.11367-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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