TY - JOUR
T1 - Editor's Choice - Ten-year Experience with Endovascular Repair of Thoracoabdominal Aortic Aneurysms
T2 - Results from 166 Consecutive Patients
AU - Verhoeven, E. L. G.
AU - Katsargyris, A.
AU - Bekkema, F.
AU - Oikonomou, K.
AU - Zeebregts, C. J. A. M.
AU - Ritter, W.
AU - Tielliu, I. F. J.
PY - 2015/5
Y1 - 2015/5
N2 - Objective: To present a 10 year experience with endovascular thoracoabdominal aortic aneurysm (TAAA) repair using fenestrated and branched stent grafts.Materials and methods: Consecutive patients with TAAA treated with fenestrated and branched stent grafts within the period January 2004-December 2013. Data were collected prospectively.Results: 166 patients (125 male, 41 female, mean age 68.8 +/- 7.6 years) were treated. The mean TAAA diameter was 71 +/- 9.3 mm. Types of TAAA were: type I, n = 12 (7.2%), type II, n = 50 (30.1%), type III, n = 53 (31.9%), type IV, n = 41 (24.8%), and type V, n = 10 (6%). Fifteen (9%) patients had an acute TAAA (11 contained rupture, 4 symptomatic). One hundred and eight (65%) patients were refused for open surgery earlier. Seventy eight (47%) patients had previously undergone one or more open/endovascular aortic procedures. Technical success was 95% (157/166). Thirty day operative mortality was 7.8% (13/166), with an in hospital mortality of 9% (15/166). Pen-operative spinal cord ischemia (SCI) was observed in 15 patients (9%), including permanent paraplegia in two (1.2%). Mean follow up was 29.2 +/- 21 months. During follow up 40 patients died, two of them probably from aneurysm related cause. Re-intervention, mostly by endovascular means, was needed in 40 (24%) patients. Estimated survival at 1, 2, and 5 years was 83% +/- 3%, 78% +/- 3.5%, and 66.6% +/- 6.1%, respectively. Estimated target vessel stent patency at 1, 2, and 5 years was 98% +/- 0.6%, 97% +/- 0.8%, and 94.2% +/- 1.5%, respectively. Estimated freedom from re-intervention at 1 and 3 years was 88.3% +/- 2.7%, and 78.4% +/- 4.5%, respectively.Conclusions: Endovascular repair of TAAA with fenestrated and branched stent grafts in high volume centers appears safe and effective in the mid-term in a high risk patient cohort. A considerable reintervention rate should be acknowledged, however. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
AB - Objective: To present a 10 year experience with endovascular thoracoabdominal aortic aneurysm (TAAA) repair using fenestrated and branched stent grafts.Materials and methods: Consecutive patients with TAAA treated with fenestrated and branched stent grafts within the period January 2004-December 2013. Data were collected prospectively.Results: 166 patients (125 male, 41 female, mean age 68.8 +/- 7.6 years) were treated. The mean TAAA diameter was 71 +/- 9.3 mm. Types of TAAA were: type I, n = 12 (7.2%), type II, n = 50 (30.1%), type III, n = 53 (31.9%), type IV, n = 41 (24.8%), and type V, n = 10 (6%). Fifteen (9%) patients had an acute TAAA (11 contained rupture, 4 symptomatic). One hundred and eight (65%) patients were refused for open surgery earlier. Seventy eight (47%) patients had previously undergone one or more open/endovascular aortic procedures. Technical success was 95% (157/166). Thirty day operative mortality was 7.8% (13/166), with an in hospital mortality of 9% (15/166). Pen-operative spinal cord ischemia (SCI) was observed in 15 patients (9%), including permanent paraplegia in two (1.2%). Mean follow up was 29.2 +/- 21 months. During follow up 40 patients died, two of them probably from aneurysm related cause. Re-intervention, mostly by endovascular means, was needed in 40 (24%) patients. Estimated survival at 1, 2, and 5 years was 83% +/- 3%, 78% +/- 3.5%, and 66.6% +/- 6.1%, respectively. Estimated target vessel stent patency at 1, 2, and 5 years was 98% +/- 0.6%, 97% +/- 0.8%, and 94.2% +/- 1.5%, respectively. Estimated freedom from re-intervention at 1 and 3 years was 88.3% +/- 2.7%, and 78.4% +/- 4.5%, respectively.Conclusions: Endovascular repair of TAAA with fenestrated and branched stent grafts in high volume centers appears safe and effective in the mid-term in a high risk patient cohort. A considerable reintervention rate should be acknowledged, however. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
KW - Aortic aneurysm
KW - Branched
KW - Endovascular repair
KW - Fenestrated
KW - Thoracoabdominal
U2 - 10.1016/j.ejvs.2014.11.018
DO - 10.1016/j.ejvs.2014.11.018
M3 - Editorial
VL - 49
SP - 524
EP - 531
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
SN - 1078-5884
IS - 5
ER -