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REVIEW  THORACIC AORTIC CHALLENGES 

Italian Journal of Vascular and Endovascular Surgery 2020 March;27(1):69-75

DOI: 10.23736/S1824-4777.19.01428-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Open thoracoabdominal aortic aneurysm repair in the endovascular era

Akiko TANAKA, Kristofer M. CHARLTON-OUW

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA



INTRODUCTION: Management of abdominal and descending thoracic aortic aneurysms has undergone a major shift from open surgical repair to endovascular repair over the past two decade. However, open repair remains the mainstay to treat thoracoabdominal aortic aneurysm due to the anatomical complexity, involvement of vital branches that feed the visceral organs and the spinal cord. We sought to review the current organ protection strategies and outcomes for open TAAA repair in the modern endovascular area.
EVIDENCE ACQUISITION: The following databases were used for search: Pubmed, Embase, and Cochrane Library. The following MeSH terms were used: thoracoabdominal aortic aneurysm, open repair, visceral protection, renal protection, spinal protection.
EVIDENCE SYNTHESIS: For overall outcomes, trials, reviews and case series with patient numbers of greater than 20 were included. For organ protection strategies, all the trials, case reports and animal experiments were reviewed as we focused on the most updated open TAAA repair techniques. The research was limited to the last 10 years, ending September 1, 2019.
CONCLUSIONS: Data confirm that it is reasonable to refer patients who require open thoracoabdominal aortic repair to high-volume centers or centers of excellence when feasible. Through the use of adjunctive measures for organ protection, open repair can be performed with acceptable surgical risks with superior durability compared to endovascular techniques. Therefore, open repair should be the treatment of choice for low-risk patients, young patients, those with inheritable aortic disease or connective tissue disorders, and in those with unfavorable anatomy for endovascular repair.


KEY WORDS: Aortic aneurysm, thoracic; Endovascular procedures; Review

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