Single Center Experience with Endovascular Repair of Acute Thoracoabdominal Aortic Aneurysms

Abstract

Purpose To investigate feasibility and outcomes of endovascular repair for acute thoracoabdominal aortic aneurysms (TAAA). Materials and Methods Data from a single center were retrospectively analyzed. Patients who underwent endovascular repair for acute TAAA between January 2010 and April 2020 were included. Perioperative and mid-term follow-up outcomes were analyzed. Survival, freedom from reintervention, and target vessel patency were calculated by Kaplan–Meier analysis. Results A total of 30 patients (18 men, 67.5 ± 6.9 years) underwent endovascular repair for acute symptomatic ( n = 15) or contained ruptured ( n = 15) TAAA. An off-the-shelf four-branched stent-graft (T-Branch) was used in 19 (63.3%) patients, a custom-made device (CMD) with expedite order in 5 (16.7%) patients, a CMD with short anticipated delivery time in 3 (10.0%) patients, and a CMD available in the hospital in 3 (10.0%) patients. Technical success was 90.0% ( n = 27). Thirty-day mortality was 10% ( n = 3). There was no complete persistent paraplegia, but one (3.3%) patient suffered permanent limb weakness. Estimated survival at 1 and 2 years was 86.3% ± 6.4%, and 82.3% ± 7.2%, respectively. Estimated freedom from reintervention at 1 and 2 years was 81.4% ± 7.6% and 73% ± 8.8%. Estimated target vessel patency at 1 and 2 years was 96.6% ± 2% and 92.6% ± 2.9%. Conclusion Endovascular treatment of acute TAAA in this selected group of patients was associated with low early mortality and excellent mid-term survival. The off-the-shelf stent-graft option (T-Branch) was used in the majority of patients. Endovascular repair should be considered the first option for suitable acute TAAA.

Frequency and type of interval adverse events during the waiting period to complex aortic endovascular repair

“…aneurysms. 8 For those patients with a very long waiting time (>120 days), we could only find specific reasons for 16%. These reasons were linked to underlying medical comorbidities, thereby potentially indicating room for improvement in the overall management algorithm.…”