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Methods: A consecutive 123 patients who survived proximal AAD surgery were reviewed at a single institution. The medical charts and computed tomography (CT) studies of these patients were reviewed from 2005 to 2014. The short axis area of the true lumen (TL), the false lumen (FL), and the total cross-sectional area were measured from reconstructed images using centerline technique at the largest segment each of the aortic arch, descending thoracic aorta (TA), aorta proximal to the celiac artery, and abdominal aorta. Survival and time to first reoperation were analyzed with Kaplan-Meier and Cox proportional hazards models. Factors associated with radiologic change were evaluated using multiple linear regression models. A significant change was defined as >10% change from the baseline CT angiogram. Results: Mean interval (baseline and the comparison CT scan) was 779 days. At least one sequential CT scan was available for 67 (55%) of the 123 patients (43 male, 34 female; mean age, 59.6 years). In general, the TA and FL increased in size during the study period (Fig; blue, TA; red, FL). Multivariate analysis showed that age >60 years and smoking were significantly associated with an increase in TL over time, whereas coronary artery disease and chronic obstructive pulmonary disease were associated with a decrease in TL (P ¼ .03). Hyperlipidemia and coronary artery disease were associated with an increase in FL size. Pre-existing aortic aneurysm, coronary surgery, and hemodialysis were significant risk factors for reoperations (P ¼ .029). Age >60 years (P ¼ .01), chronic obstructive pulmonary disease (P ¼ .002), and male gender (P ¼ .02) were also associated with an increase in total area, signifying distal aneurysmal progression. Conclusions: Patient risk factors predict unfavorable long-term morphologic outcomes in the remaining aortic tree after AAD surgical repair. These factors should be used as markers to identify patients who may benefit from closer surveillance and possibly earlier endovascular intervention to the distal TA.

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This article details a novel technique in the treatment of a symptomatic thoracoabdominal aneurysm (TAA) involving the visceral segment and an infrarenal abdominal aortic aneurysm. The patient was treated in a 2-staged hybrid approach combining an endovascular repair of the infrarenal segment, followed by open TAA repair. The large visceral arteries were revascularized using expanded polytetrafluoroethylene GORE Hybrid Vascular Graft (GHVG) and a Gradual Funneling Technique with Dacron graft. This method assured a complete hemostatic seal and minimized visceral ischemic time. To our knowledge, this is the first case of sutureless visceral artery revascularization using GHVG reported in the literature.

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