Outcomes after endovascular versus open thoracoabdominal aortic aneurysm repair: A population-based study

Rocha, Rodolfo V.; Lindsay, Thomas F.; Austin, Peter C.; Al‐Omran, Mohammed; Forbes, Thomas L.; Lee, Douglas S.; Ouzounian, Maral

doi:10.1016/j.jtcvs.2019.09.148

Cited by 58 publications

(30 citation statements)

References 34 publications

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“…TAAA is a complex pathology, burdened by a high perioperative mortality rate, reaching 17% for open repair and 10% for endovascular repair in a recent populationbased analysis by Rocha et al, 26 which can be decreased to 4% to 16% when considering only high-volume centers, as noted by Cowan et al 27,28 Treatment for pD-TAAA represents an adjunctive challenge both for open and endovascular repair owing to the fragility of the aortic wall, the narrowness of the true lumen, and the possible extension of the dissection into visceral and iliac vessels. This meta-analysis reported a 30-day overall mortality of 5%, without significant differences between open and endovascular repair of pD-TAAA, in highly selected centers dedicated to complex aortic pathology.…”

Section: Discussionmentioning

confidence: 99%

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Verzini

Gibello

Varetto

et al. 2021

Journal of Vascular Surgery

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Objective: To determine outcomes of postdissection thoracoabdominal aneurysms by either open or endovascular repair with fenestrated or branched endografts.Methods: A systematic review was conducted for open or endovascular repair of postdissection thoracoabdominal aneurysms, between January 2009 and February 2020. A meta-analysis was performed for postoperative complications and both early and late mortality and reinterventions.Results: Fifteen noncomparative studies (eight endovascular repair and seven open repair) were suitable for metaanalysis. Overall, 1337 patients were included, 1068 in the open repair group (73% male; mean age 58 years) and 269 in the endovascular repair group (79% male; mean age 65 years). The 30-day mortality was 6% for open repair vs 3% for endovascular repair (P ¼ .35), whereas the 30-day reintervention rate was 3% for open repair vs 1% for endovascular repair (P ¼ .66). The only significant difference was reported for 30-day respiratory complication rate (30% open repair vs 2% endovascular repair; P < .01). The incidence of spinal cord ischemia was 9% for open repair vs 8% for endovascular repair (P ¼ .95). The mean follow-up was 44 months: 48 months (range, 10-72 months) after open repair and 17 months (range, 12-25 months) after endovascular repair (P < .01). Late aortic reinterventions were more frequent after endovascular repair (11% vs 32%; P < .001). The late overall mortality rate was 19% for open repair vs 7% for endovascular repair (P ¼ .08), whereas aortic-related mortality was 7% for open repair vs 3% for endovascular repair (P ¼ .22).Conclusions: In the absence of comparative studies, this meta-analysis showed that endovascular repair seems to be a viable alternative for patients unfit for open repair.

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Section: Discussionmentioning

confidence: 99%

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Verzini

Gibello

Varetto

et al. 2021

Journal of Vascular Surgery

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“…Experienced centers report rates of secondary procedures ranging from 14% to 30%. 34,39,[53][54][55] In their meta-analysis, Rocha and colleagues 51 reported that secondary procedures on the thoracoabdominal aorta or its branches were significantly more frequent after endovascular repair than after open repair during a median of 3.5 years of follow-up (p < 0.01). At eight years, 23.3% of the endovascular group needed one or more secondary procedures on the thoracoabdominal aorta or its branches, compared with 12.5% of the open group (p < 0.01).…”

Section: Durabilitymentioning

confidence: 99%

Open vs. endovascular thoracoabdominal aortic aneurysm repair: tale of the tape

Çekmeceli̇oğlu

Orozco-Sevilla

Coselli³

2020

Asian Cardiovasc Thorac Ann

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Open surgical repair persists as the gold-standard operation for thoracoabdominal aortic aneurysm; however, endovascular repair has become commonplace. Technical considerations in thoracoabdominal aortic aneurysm treatment are particularly complex, insofar as it involves critical branching arteries feeding the visceral organs. Newer, low-profile devices make total endovascular thoracoabdominal aortic aneurysm repair more feasible and, thus, appealing. For younger and low-risk patients, the choice between open and endovascular therapy remains controversial. Despite the advantages of a minimally invasive procedure, data suggest that endovascular aortic repair incurs a greater risk of spinal cord deficit, and the durability of endovascular aortic repair remains unclear. It is difficult to compare outcomes between endovascular and open thoracoabdominal aortic aneurysm repair, primarily because of the current investigational status of endovascular devices, the variety of approaches to endovascular repair, differing patient populations, lack of prospective randomized studies, and minimal medium- and long-tern follow-up data on endovascular repair. When deciding between open and endovascular approaches, one should consider which is more suitable for each patient. Older patients generally benefit from a less invasive approach. Open repair should be considered for young patients and those with heritable thoracic aortic disease. Infection and fistulae are best treated by open repair, although endovascular intervention as a lifesaving bridge to definitive repair has evolved to become a critical component of initial treatment. It is crucial to have technical expertise in both open and endovascular procedures to provide the best aortic repair for the patient. This may require dedicated aortic programs at tertiary institutions.

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“…Although a recent meta-analysis by this group 6 demonstrated a survival benefit for patients undergoing endovascular rather than open TAAA repair, their current population-based study concluded that overall survival at 8 years was not significantly different between the 2 treatment options. 2 Deciphering these results in the broader context of endovascular versus open repair as a superior treatment for TAAA is challenging. The incidence and prevalence of patients with TAAA is low, and consequently, published studies must pool the highly varied types of TAAA repair (ie, Crawford extents I-IV TAAA repair) together to gather sufficient data.…”

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confidence: 99%

Commentary: Aortic repair in the Great White North—endovascular or open, eh?

Huu¹,

Coselli²

2021

The Journal of Thoracic and Cardiovascular Surgery

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Open thoracoabdominal aortic aneurysm (TAAA) repair is among the most technically complex surgical procedures performed today. Even in high-volume centers of excellence, the incidence of mortality and morbidity remains daunting. As a result, the advent of endovascular repair for TAAA has been greeted with much enthusiasm and celebrated as a less-invasive treatment for a potentially fatal pathology. For high-risk patients, the propaganda has been nothing short of a panacea. In the last decade, endovascular repair of the descending thoracic aorta has largely superseded open repairs. 1 Such a dramatic shift in management strategy has ignited a firestorm of debate over which method should be used to treat TAAA. However, this revolutionary endovascular technology is a recent phenomenon-longterm outcomes of endovascular TAAA repair are simply not available.With their work, Rocha and colleagues 2 sought to determine the individual benefits of these 2 treatment strategies as performed in Ontario, Canada, using comprehensive provincial data. With a propensity-matched analysis for 241 patients undergoing open or endovascular repair of TAAA, they found that open procedures had a greater rate of in-hospital mortality and life-altering complications. These results were not unexpected, because the risks of open procedures are understood to be up-front, with traditional benefits perceptible long term. Their data also demonstrate that endovascular TAAA repairs had greater rates of reintervention compared with open procedures, thus affirming that an endovascular repair may not be as durable. This is not a benign finding-endovascular reintervention is not necessarily a free ride; studies suggest that subsequent interventions are associated with increased mortality rates. 3,4 Our own work has demonstrated that open TAAA repair is durable. 5

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Outcomes after endovascular versus open thoracoabdominal aortic aneurysm repair: A population-based study

Cited by 58 publications

References 34 publications

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Open vs. endovascular thoracoabdominal aortic aneurysm repair: tale of the tape

Commentary: Aortic repair in the Great White North—endovascular or open, eh?

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