Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 451-457 |
| Number of pages | 7 |
| Journal | Zentralblatt für Chirurgie |
| Volume | 136 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Oct-2011 |
Keywords
- thoracic aorta
- aortic aneurysm
- stent prosthesis
- endovascular treatment
- THORACOABDOMINAL AORTIC-ANEURYSMS
- STENT-GRAFTS
- FENESTRATED ENDOGRAFTS
- JUXTARENAL ANEURYSMS
- COMPLICATIONS
- EXPERIENCE
- MORTALITY
- OUTCOMES
- SURGERY
- RISK
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In: Zentralblatt für Chirurgie, Vol. 136, No. 5, 10.2011, p. 451-457.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Results of Endovascular Repair of TAAA in the First 50 Patients
AU - Verhoeven, E.
AU - Tielliu, I. F.
AU - Zeebregts, C. J.
AU - Bekkema, F.
AU - Vourliotakis, G.
AU - Ritter, W.
AU - Zipfel, B.
AU - Renner, H.
PY - 2011/10
Y1 - 2011/10
N2 - Background: Developments with fenestrated and branched stent grafts have opened the way to treat complex aortic aneurysms involving the visceral arteries. First reports on endovascular treatment of thoracoabdominal aneurysms have demonstrated the feasibility of the technique.Methods: A literature review and results of first 50 patients treated with a custom-made Zenith device with fixed branches are presented. Most of the patients were refused open surgery mainly for the extent of the disease combined with co-morbidity, which included in most patients a combination of several risk factors. Mean aneurysm size was 71 mm and extent of the aneurysm was type I (n=9), type II (n=13), type III (n=19), and type IV (n=9), respectively.Results: Primary and primary assisted technical successes in our series were 88% (44/50) and 92% (46/50), respectively. One patient died on day 1 from an intraoperative aneurysm rupture. In two patients a renal artery was lost, one due to rupture and one due to malpositioning of the bridging stent graft. In a fourth patient, a celiac artery could not be catheterised and was lost. Finally, in two more patients, catheterisation of in total three renal arteries proved impossible. This was solved by a retrograde approach for two renal arteries via laparotomy in one patient, and a spleno-renal bypass in the other patient. Thirty-day mortality was 8%. Estimated survival at 6 months, 1 year, and 2 years was 91.2%, 79.8%, and 69.7%, respectively. Freedom of reintervention of all kinds at 1 and 2 years was 81.9% and 73.7%, respectively.Conclusion: Results of fully endovascular repair of thoracoabdominal aneurysms in a high-risk cohort are promising. A learning curve should be expected. Although longer term results need to be awaited, it is likely that endovascular repair of thoracoabdominal aneurysms will become a preferential treatment option for many patients in the future.
AB - Background: Developments with fenestrated and branched stent grafts have opened the way to treat complex aortic aneurysms involving the visceral arteries. First reports on endovascular treatment of thoracoabdominal aneurysms have demonstrated the feasibility of the technique.Methods: A literature review and results of first 50 patients treated with a custom-made Zenith device with fixed branches are presented. Most of the patients were refused open surgery mainly for the extent of the disease combined with co-morbidity, which included in most patients a combination of several risk factors. Mean aneurysm size was 71 mm and extent of the aneurysm was type I (n=9), type II (n=13), type III (n=19), and type IV (n=9), respectively.Results: Primary and primary assisted technical successes in our series were 88% (44/50) and 92% (46/50), respectively. One patient died on day 1 from an intraoperative aneurysm rupture. In two patients a renal artery was lost, one due to rupture and one due to malpositioning of the bridging stent graft. In a fourth patient, a celiac artery could not be catheterised and was lost. Finally, in two more patients, catheterisation of in total three renal arteries proved impossible. This was solved by a retrograde approach for two renal arteries via laparotomy in one patient, and a spleno-renal bypass in the other patient. Thirty-day mortality was 8%. Estimated survival at 6 months, 1 year, and 2 years was 91.2%, 79.8%, and 69.7%, respectively. Freedom of reintervention of all kinds at 1 and 2 years was 81.9% and 73.7%, respectively.Conclusion: Results of fully endovascular repair of thoracoabdominal aneurysms in a high-risk cohort are promising. A learning curve should be expected. Although longer term results need to be awaited, it is likely that endovascular repair of thoracoabdominal aneurysms will become a preferential treatment option for many patients in the future.
KW - thoracic aorta
KW - aortic aneurysm
KW - stent prosthesis
KW - endovascular treatment
KW - THORACOABDOMINAL AORTIC-ANEURYSMS
KW - STENT-GRAFTS
KW - FENESTRATED ENDOGRAFTS
KW - JUXTARENAL ANEURYSMS
KW - COMPLICATIONS
KW - EXPERIENCE
KW - MORTALITY
KW - OUTCOMES
KW - SURGERY
KW - RISK
U2 - 10.1055/s-0031-1271550
DO - 10.1055/s-0031-1271550
M3 - Article
SN - 0044-409X
VL - 136
SP - 451
EP - 457
JO - Zentralblatt für Chirurgie
JF - Zentralblatt für Chirurgie
IS - 5
ER -