Endovascular repair of thoracoabdominal aortic aneurysm (TAAA): early experience

Kheirelseid, El-Rashid; Gardiner, Roisin; Haider, S. N.; Martin, Zenia; Colgan, Mary-Paula; O’Neill, Sean M.; Madhavan, Prakash

doi:10.1007/s11845-013-0974-2

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…Another alternative approach to traditional open repair is EVAR with endograft techniques ( 10 ). There is no doubt that a total endovascular approach would benefit patients with aortic diseases, but individualized stents may take years to become widely available ( 11 ). Treatment modalities consisting of visceral parallel graft (chimney/snorkel) techniques with off-the-shelf devices have a greater probability of causing complications such as endoleaks and displacements, so EVAR is now more beneficial for treating subrenal aortic diseases ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Debranching abdominal aortic hybrid surgery for aortic diseases involving the visceral arteries

Ma,

Feng,

Tardzenyuy

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveAortic diseases involving branches of the visceral arteries mainly include thoracoabdominal aortic aneurysm (TAAA), aortic dissection (AD) and abdominal aortic aneurysm (AAA). The focus of treatment is to reconstruct the splanchnic arteries and restore blood supply to the organs. Commonly used methods include thoracoabdominal aortic replacement, thoracic endovascular aortic repair and hybrid approaches. Hybrid surgery for aortic disease involving the visceral arteries, consisting of visceral aortic debranching with retrograde revascularization of the celiac trunk and renal arteries and using stent grafts, has been previously described and may be considered particularly appealing in high-risk patients. This study retrospectively analyzed recorded data of patients and contrasted the outcomes with those of a similar group of patients who underwent conventional open repair surgery.MethodsBetween 2019 and 2022, 72 patients (52 men) with an average age of 61.57 ± 8.66 years (range, 36–79 years) underwent one-stage debranching abdominal aortic hybrid surgery. These patients, the hybrid group, underwent preoperative Computed Tomographic Angiography (CTA) and had been diagnosed with aortic disease (aneurysm or dissection) involving the visceral arteries and were at high risk for open repair. The criteria used to define these patients as high-risk group who are in the need of hybrid treatment were American Society of Anesthesiologists (ASA) class 3 or 4. In all cases, we accomplished total visceral aortic debranching through a previous visceral artery retrograde revascularization with synthetic grafts (customized Y or four-bifurcated grafts), and aortic endovascular repair with one of two different commercially produced stent grafts (Medtronic® and Lifetech®). In some cases, we chose to connect the renal artery to the artificial vessel with a stent graft (Viabahn) and partly or totally anastomosed. We analyzed the results and compared the outcomes of the hybrid group with those of a similar group of 46 patients (36 men) with an average age 54.15 ± 12.12 years (range, 32–76). These 46 patients, the conventional open group, were selected for having had thoracoabdominal aortic replacement between 2019 and 2022.ResultsIn the hybrid group, 72 visceral bypasses were completed, and endovascular repair was successful in all cases. No intraoperative deaths occurred. Perioperative mortality was 2.78%, and perioperative morbidity was 9.72% (renal insufficiency in 1, unilateral renal infarction in 5, Intestinal ischemia in 1). At 1-month postoperative CTA showed 2 endoleaks, one of which was intervened. At follow-up, there were unplanned reoperation rate of 4.29% and 5 (7.14%) deaths. The remaining patients’ grafts were patent at postoperative CTA and no endoleak or stent graft migration had occurred. In the conventional open group, 1 died intraoperatively, 4 died perioperatively, perioperative mortality was 10.87% and complications were respiratory failure in 5, intestinal paralysis/necrosis in 4, renal insufficiency in 17, and paraplegia in 2. At follow-up, 5 (12.20%) patients presented with synthetic grafts hematoma 4 (9.76%) patient died, and 6 (14.63%) patients required unplanned reoperation intervention.ConclusionHybrid surgery is technically feasible in selected cases. For aortic diseases involving the visceral arteries, the application of hybrid abdominal aorta debranching can simplify the operation process, decrease the risks of mortality and morbidity in high-risk and high-age populations and decrease the incidence of various complications while achieving ideal early clinical efficacy. However, a larger series is required for valid statistical comparisons, and longer follow-ups are necessary to evaluate the long-term efficacy of hybrid surgery.

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Section: Introductionmentioning

confidence: 99%

Debranching abdominal aortic hybrid surgery for aortic diseases involving the visceral arteries

Ma,

Feng,

Tardzenyuy

et al. 2023

Front. Cardiovasc. Med.

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“…1 The most serious complication from a TAAA is rupture. 1,3,4 Other clinical manifestations of TAAA include congestive heart failure (associated with aortic regurgitation), compression of the trachea and/or bronchi, and compression of the esophagus. 4 Fenestrated and branched endovascular aneurysm repair (FB-EVAR) is increasingly being used to treat TAAAs.…”

Section: Introductionmentioning

confidence: 99%

Development of a Duplex Ultrasound Protocol for Baseline and Follow-Up Imaging of a Branched Aortic Endoprosthesis

Mitchell

Matsumura

Meadows

et al. 2021

Journal for Vascular Ultrasound

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Branched endoprostheses for endovascular repair of pararenal and thoracoabdominal aortic aneurysms are undergoing evaluation in prospective clinical trials. Duplex ultrasound has been a cornerstone of surveillance for vascular reconstructions. This paper describes the development and deployment of a standardized duplex imaging protocol to evaluate individuals who have undergone endovascular repair of their thoracoabdominal aortic aneurysm. Ultrasound imaging is performed after an 8 to 12 hour fast to minimize the presence of bowel gas and allow for optimal imaging of abdominal vascular structures. Doppler measurements of peak systolic and end diastolic velocity are made at specific arterial segments in the aorta and the celiac, superior mesenteric, and renal arteries. Resistive indices are also recorded in the segmental and arcuate arteries of both kidneys. Pulsed-wave Doppler is used to record spectral Doppler data and color Doppler is used to image all arterial segments and ensure proper placement of the Doppler sample volume and ensure correct angle of interrogation. Implementation of a standardized duplex ultrasound imaging protocol can be used to image and follow individuals who have received the Thoracoabdominal Branch Endoprosthesis (TAMBE) device and branched endovascular aneurysm repair (BEVAR). Ultrasound may provide complementary findings and may add information to the computed tomography angiography imaging for following these individuals.

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Endovascular versus conventional open surgical repair for thoracoabdominal aortic aneurysms

Concannon

Hynes

Veerasingam

et al. 2018

Cochrane Database of Systematic Reviews

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Endovascular repair of thoracoabdominal aortic aneurysm (TAAA): early experience

Abstract: The role of endovascular techniques in the treatment of TAAA continues to evolve. Hybrid and complete endovascular repairs do not replace conventional repair, but provide an alternative for high-risk patients who might otherwise be denied treatment.

Cited by 6 publications

References 32 publications

Debranching abdominal aortic hybrid surgery for aortic diseases involving the visceral arteries

Debranching abdominal aortic hybrid surgery for aortic diseases involving the visceral arteries

Development of a Duplex Ultrasound Protocol for Baseline and Follow-Up Imaging of a Branched Aortic Endoprosthesis

Endovascular versus conventional open surgical repair for thoracoabdominal aortic aneurysms

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