Endovascular stent-graft repair of pararenal and type IV thoracoabdominal aortic aneurysms with adjunctive visceral reconstruction

Fulton, Joseph J.; Farber, Mark A.; Marston, William A.; Mendes, Robert; Mauro, Matthew A.; Keagy, Blair A.

doi:10.1016/j.jvs.2004.10.049

Cited by 100 publications

(70 citation statements)

References 28 publications

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“…15.5%); however, there was great heterogeneity among the 18 eligible studies that provided adequate data 7,8,[13][14][15][16][17][18][19][20][21][22][23][25][26][27][28][29] (I 2 ϭ76.5%, 95% CI, 61.1%-84%). With respect to not supported renal insufficiency, we extracted available data from 17 studies.…”

Section: Moulakakis Et Al Hybrid Technique In Thoracoabdominal Patholmentioning

confidence: 99%

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

et al. 2011

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Background-Many authors using a hybrid debranching strategy for the treatment of thoracoabdominal pathologies have reported disappointing results and the initial enthusiasm for the technique has given way to criticism and ambiguity. The aim of the present meta-analysis study was to assess the safety and efficacy of the technique in patients with thoracoabdominal aortic aneurysms or other aortic pathologies. Methods and Results-A multiple electronic search was performed on all articles describing hybrid open endovascular repair. Separate meta-analyses were conducted for technical success, visceral graft patency, spinal cord ischemia symptoms, renal insufficiency, and other complications as well as 30-day/in-hospital mortality. Nineteen publications with a total of 507 patients were analyzed. The pooled estimates for primary technical success and visceral graft patency were 96.2% (95% CI, 93.5%-98.2%) and 96.5% (95% CI, 95.2%-97.8%) respectively. A pooled rate of 7.5% (95% CI, 5.0%-11.0%) for overall spinal cord ischemia symptoms was observed; whereas for irreversible paraplegia the pooled rate was 4.5% (95% CI, 2.5%-7.0%). The pooled estimate for renal failure was 8.8% (95% CI, 3.9%-15.5%). The pooled 30-day/in-hospital mortality rate was 12.8% (95% CI, 8.6%-17.0%). During the mean follow-up period of 34.5 (95% CI, 31.5-37.5) months, a total of 119 endoleaks were identified in 111 patients (22.7%). Conclusions-The repair of thoracoabdominal pathologies by means of hybrid procedures in patients who are poor surgical candidates is still associated with significant morbidity and mortality rates. Future studies may substantiate whether the technique is amenable to amelioration and improvement. (Circulation. 2011;124:2670-2680.)

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Section: Moulakakis Et Al Hybrid Technique In Thoracoabdominal Patholmentioning

confidence: 99%

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

et al. 2011

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“…So to, it would appear, is the fate of open abdominal reconstruction. While EVAR Has boasted welldocumented benefits [20][21][22] over open repair including a reduction of aneurysm-related mortality, a decrease in perioperative cardiopulmonary complications as well as of hemorrhage, graft infection and colonic ischemia, as well as reduced patient trauma, reduced hospital stays and faster recovery 20 . Even in the face of the EVAR 1 data suggesting that After 12 months there was negligible difference in Health Related Quality of Life (HRQL) between the two groups (EVAR vs Open) 23 .…”

Section: Sizementioning

confidence: 99%

Abdominal Aortic Aneurysms: Changing Paradigms in Treatment

Marrocco¹,

Bush²

2011

Aneurysmal Disease of the Thoracic and Abdominal Aorta

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“…On the other hand, several institutions have reported mortality rates as low as 0% 10,11 with the hybrid open endovascular technique. Although the authors hypothesize that these improved results may be secondary to a learning curve related to the procedure, 2 institutions with no mortality treated relatively low volumes of patients, 10 and 17 patients, whereas the group with the largest series, 107 patients, had a 30-day mortality of 14.9%.…”

Section: Article See P 2670mentioning

confidence: 99%

“…4 However, the in-hospital mortality of 26% in our series and 1-year mortality of 32% provide a sobering perspective on the potential long-term risks of hybrid intervention in these patients. These outcomes have certainly caused us to apply this strategy conservatively in patients deemed unfit for open TAAA repair.On the other hand, several institutions have reported mortality rates as low as 0% 10,11 with the hybrid open endovascular technique. Although the authors hypothesize that these improved results may be secondary to a learning curve related to the procedure, 2 institutions with no mortality treated relatively low volumes of patients, 10 and 17 patients, whereas the group with the largest series, 107 patients, had a 30-day mortality of 14.9%.…”

mentioning

confidence: 99%

Are Improved Results for Hybrid Repair of Thoracoabdominal Aortic Aneurysms Due to a Learning Curve or Better Patient Selection?

Kwolek

2011

Circulation

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pen repair of thoracoabdominal aortic aneurysms (TAAAs) has traditionally been accompanied by significant morbidity and mortality. The use of adjuncts such as hypothermia and selective visceral perfusion has decreased the rates of permanent paraplegia to Ͻ5%, renal failure requiring dialysis to Ͻ5%, and 30-day mortality to Ͻ10% when performed in high-volume centers of excellence. 1,2 However, when this operation is applied across a broad spectrum of institutions, the overall morbidity and mortality can be significantly higher. One statewide registry reported a 1-year mortality rate of 40% when TAAA repair was performed in patients Ͼ75 years of age. 3 In addition, there exists a subset of patients who are considered too high risk for open repair, usually because of the severity of their underlying pulmonary disease and other medical comorbidities. 4 Article see p 2670Thus, vascular interventionalists have searched for less morbid ways to treat these complex patients. The use of thoracic endografts has been demonstrated to decrease the overall morbidity and mortality of patients undergoing repair of both elective and emergent thoracic aortic pathology. 5,6 However, the availability of branched endografts to treat TAAAs involving the visceral vessels has been limited, particularly in the United States. 7,8 Thus, the concept of combining a lesser open abdominal operation to bypass the visceral and renal vessels with the placement of an endovascular stent graft in the descending thoracic aorta has been developed as a hybrid open endovascular technique. As Moulakakis et al 9 point out in this issue of Circulation, no prospective randomized trials have compared hybrid open endovascular technique procedures with standard open TAAA repair, repair using branched endovascular grafts, or even best medical therapy. Current results from multiple single-center series describe a wide range of morbidity and mortality.Moulakakis et al 9 performed a meta-analysis of 19 series published over the past decade describing the results of hybrid TAAA repair in 507 patients. Despite the wide range of outcomes, the pooled estimates for 30-day mortality of 12.8% (95% confidence interval, 8.6 to 17), for irreversible paraplegia of 4.5% (95% confidence interval, 2.5 to 7.0), and for renal impairment requiring dialysis of 8.8% (95% confidence interval, 3.9 to 15.5) seem to provide a realistic expectation of potential outcomes in this high-risk group of patients. 9 We reported a slightly higher 30-day mortality of 17.4% with a comparable paraplegia rate of 4.3% and rates of renal insufficiency similar to that of open repair in a series of 23 high-risk patients undergoing debranching procedures. 4 However, the in-hospital mortality of 26% in our series and 1-year mortality of 32% provide a sobering perspective on the potential long-term risks of hybrid intervention in these patients. These outcomes have certainly caused us to apply this strategy conservatively in patients deemed unfit for open TAAA repair.On the other hand, several institutions ...

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Endovascular stent-graft repair of pararenal and type IV thoracoabdominal aortic aneurysms with adjunctive visceral reconstruction

Cited by 100 publications

References 28 publications

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies

Abdominal Aortic Aneurysms: Changing Paradigms in Treatment

Are Improved Results for Hybrid Repair of Thoracoabdominal Aortic Aneurysms Due to a Learning Curve or Better Patient Selection?

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