Editor's Choice - Ten-year Experience with Endovascular Repair of Thoracoabdominal Aortic Aneurysms: Results from 166 Consecutive Patients

E. L. G. Verhoeven*, A. Katsargyris, F. Bekkema, K. Oikonomou, C. J. A. M. Zeebregts, W. Ritter, I. F. J. Tielliu

*Corresponding author for this work

Research output: Contribution to journalEditorialAcademicpeer-review

188 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)524-531
Number of pages8
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume49
Issue number5
DOIs
Publication statusPublished - May-2015

Keywords

  • Aortic aneurysm
  • Branched
  • Endovascular repair
  • Fenestrated
  • Thoracoabdominal

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