Comparative outcomes of open, hybrid, and fenestrated branched endovascular repair of extent II and III thoracoabdominal aortic aneurysms

Arnaoutakis, Dean J.; Scali, Salvatore T.; Beck, Adam W.; Kubilis, Paul; Huber, Thomas S.; Martin, Andrew; Laquian, Liza; Back, Martin R.; Giles, Kristina A.; Fatima, Javairiah; Beaver, Thomas M.; Upchurch, Gilbert R.

doi:10.1016/j.jvs.2019.08.236

Cited by 57 publications

(20 citation statements)

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“…Nearly all studies had a retrospective design and most (eight studies 12,13,15,16,18e21 ) were multicentre. Five studies were conducted in the USA, 11,12,17,19,21 two in Italy, 16,20 two in France, 15,18 and the remaining two in Germany 13 and Thailand. 14 The study characteristics are summarised in Table 1, and the individual study inclusion and exclusion criteria for patient selection and length of follow up are presented in Table S1 (see Supplementary Material).…”

Section: Description Of Included Studiesmentioning

confidence: 99%

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Editor's Choice – Fenestrated or Branched Endovascular versus Open Repair for Complex Aortic Aneurysms: Meta-Analysis of Time to Event Propensity Score Matched Data

Antoniou

Juszczak

Antoniou

et al. 2021

European Journal of Vascular and Endovascular Surgery

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Section: Description Of Included Studiesmentioning

confidence: 99%

“…19,21 Seven studies compared outcomes in propensity score matched patients. 11,13,15,16,18,20,21 The remaining four used multiple Cox regression or multivariable models to adjust for confounding factors (Table S3; see Supplementary Material).…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Editor's Choice – Fenestrated or Branched Endovascular versus Open Repair for Complex Aortic Aneurysms: Meta-Analysis of Time to Event Propensity Score Matched Data

Antoniou

Juszczak

Antoniou

et al. 2021

European Journal of Vascular and Endovascular Surgery

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“…Endovascular options to treat these patient subsets are constantly in flux, and determining when best to utilize endovascular techniques is not always clear. 17 , 18 Achieving a balance between TEVAR under-utilization and over-utilization relative to long-established medical and surgical treatments requires collective oversight. Specialties less adept at endovascular techniques may have a tendency to under-refer patients for such therapies, whereas specialties heavily invested in endovascular care may inadvertently overuse the technology in select situations.…”

Section: Discussionmentioning

confidence: 99%

The Many Care Models to Treat Thoracic Aortic Disease in Canada: A Nationwide Survey of Cardiac Surgeons, Cardiologists, Interventional Radiologists, and Vascular Surgeons

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The downside is that it still requires laparotomy and long operative time. Although the hybrid repair was developed as a less-invasive approach than the traditional open TAAA repair, the 30-day mortality after hybrid techniques in many series are disappointingly high, ranging from 10% to 26%, 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 which may be due to the technique being applied to patients unfit or high-risk for traditional open TAAA repair. Controversial excellent outcomes were reported by Patel and colleagues in 2010, 14 with only 1 death in the series of 29 hybrid repairs, and Yang and colleagues in 2020, 15 with 1 death in the series of 28 hybrid repairs.…”

Section: Hybrid Taaa Repairmentioning

confidence: 99%

“…Outcomes after hybrid TAAA repairs with more than 10 cases in the series published after 2000 are summarized in Table 1 . 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 …”

Section: Hybrid Taaa Repairmentioning

confidence: 99%

Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels

2021

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Open thoracoabdominal aortic aneurysm (TAAA) repair remains a surgical challenge. Hybrid and total endovascular repair have emerged as alternatives in treating TAAA. Total endovascular TAAA repair may be best performed with branched/ fenestrated stent grafts. However, these technologies are not yet widely available. Thus, currently total endovascular TAAA repair using the chimney/snorkel techniques is considered a viable option in many centers.In this article, we briefly review 2 readily available techniques with off-the-shelf devices, hybrid procedure using total abdominal debranching, and total endovascular repair using chimney/snorkel procedures. The hybrid TAAA repair avoids thoracotomy but requires laparotomy and carries high morbidity and mortality (eg, operative mortality, 4%-26% and renal failure, 4%-26%), comparable to traditional open repair. The staged hybrid approach has been proposed to minimize the invasiveness of the procedure, whereas the associated risk of interval aortic deaths is not negligible. Total endovascular repair reduces the morbidity and mortality after TAAA repair (eg, operative mortality, 3%-20% and renal failure, 0%-20%). However, it is technically demanding and the risks of future reinterventions-and need for repetitive surveillance-is inevitable (eg, immediate type I endoleak, 7%-16% and 1-year branch patency, 93%-98%). Currently, there are not enough data to determine which less-invasive option for open repair in patients with TAAA is superior. These alternatives should complement each other and be applied to carefully selected populations as a part of the overall toolbox in treating TAAA. (JTCVS Techniques 2021-:1-6) Illustration of the sandwich technique. CENTRAL MESSAGEMore data are required to determine the best option for open TAAA repair. Options should complement one another and be applied to selected populations as a part of the overall toolbox to treat TAAA. See Commentary on page XXX.Video clip is available online. BACKGROUNDOpen thoracoabdominal aortic aneurysm (TAAA) repair remains among the most difficult surgical challenges due to the associated vital structures, such as visceral/renal branches and segmental arteries involved in the lesion. Recent reports from large-volume aortic centers demonstrate operative mortality after open TAAA repairs in young patients (younger than age 50 years) is 3% to 6%. 1,2 However, despite the evolution in surgical techniques and perioperative care, mortality in older patients remains 8% to 17%, even in experienced hands. 1,2 Hybrid procedures, which combine open and endovascular techniques, to treat TAAA has been proposed 3 to minimize the surgical insults and improve outcomes, especially in high-risk patients. Another alternative approach to traditional open repair is total endovascular repair with visceral parallel graft (chimney/snorkel) techniques using off-the-shelf devices. Further, physicianmodified, multibranched stent graft was introduced in 2001, 4 and now off-the-shelf and custom-made branched/fenestrated stent grafts to t...

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Comparative outcomes of open, hybrid, and fenestrated branched endovascular repair of extent II and III thoracoabdominal aortic aneurysms

Cited by 57 publications

References 41 publications

Editor's Choice – Fenestrated or Branched Endovascular versus Open Repair for Complex Aortic Aneurysms: Meta-Analysis of Time to Event Propensity Score Matched Data

Editor's Choice – Fenestrated or Branched Endovascular versus Open Repair for Complex Aortic Aneurysms: Meta-Analysis of Time to Event Propensity Score Matched Data

The Many Care Models to Treat Thoracic Aortic Disease in Canada: A Nationwide Survey of Cardiac Surgeons, Cardiologists, Interventional Radiologists, and Vascular Surgeons

Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels

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