Long-term Follow-Up Following Advanced Endovascular Thoracoabdominal Aortic Aneurysm Repair: A Single-Center Experience

Abstract

We reviewed our institutional outcomes of patients with thoracoabdominal aortic aneurysms (TAAA) repaired using branched or fenestrated endovascular devices for complications including TAAA life-altering events, a composite of mortality, permanent paraplegia, permanent dialysis, stroke, and long-term survival. Data were collected both prospectively and retrospectively with institutional ethics approval. Seventy-eight consecutive patients underwent endovascular TAAA repair using branched-fenestrated endovascular aneurysm repair stent grafts at our institution from June 2008 to July 2019 (47 male; mean age, 74 ± 7 years). Graft designs included 68 patient-customized devices and 9 off-the-shelf grafts. Median follow-up was 5.43 years. Mean aneurysm size at presentation was 70 ± 8 mm and Crawford extents were three type I (3.9%), 18 type II (23.4%), 22 type III (28.6%), 31 type IV (40.2%) and 3 type V (3.9%). The Table highlights patient baseline demographic characteristics. Graft deployment was successful in all patients. Target vessel revascularization was successful in 276 of 290 (95.2%) vessels: 57 of 65 celiac arteries, 76 of 76 superior mesenteric arteries, 74 of 76 right renal arteries, and 69 of 73 left renal arteries. Seventeen branches over 16 (20.5%) patients required reintervention for occlusion, endoleaks, and/or target vessel realignment during their hospital stay. Thirty-day mortality was observed in eight (10.3%) patients. In the surviving patients, 13 (18.6%) developed perioperative spinal cord ischemia: three (4.3%) patients with temporary paraparesis, three with temporary paraplegia, three with permanent paraparesis, and four (5.7%) patients with permanent paraplegia. Postoperative stroke occurred five 6.4%) patients, acute myocardial infarction in six (7.7%) patients, one (1.3%) patient suffered renal failure requiring permanent dialysis at discharge, and three (3.8%) patients suffered bowel ischemia requiring reintervention. At 5 and 9 years, freedom from all-cause mortality was 54% (95% confidence interval, 0.42-0.70) and 29.3% (95% confidence interval, 0.16-0.53), respectively (Figure). There were no deaths related to aneurysm rupture. Endovascular repair of TAAAs was associated with a high rate of technical success and prevented short and long-term rupture. While the rate of early mortality and morbidity is low, secondary reintervention rates indicate the need for further improvements and continuous patient follow-up. Our data include one of the longest median follow-up durations of endovascular TAAA repair, which highlights the durability of the procedure and compares favorably to survival Results to population-based outcomes and centers of excellence across the globe.TableClinical and aneurysm characteristics of the 78 patients in the studyVariableAge74 ± 6.9Male, n (%)47 (60.3)Urgent or emergent10 (12.8)Crawford classification extent I3 (3.9) II18 (23.4) IIII22 (28.6) IV31 (40.2) V3 (3.9)Staged procedure30 (38.5)Smoking (current or past)64 (82.1)Hypertension71 (91.0)Diabetes mellitus13 (16.7)Dyslipidemia42 (54.5)Chronic obstructive pulmonary disease36 (46.8)Cerebrovascular disease (stroke/TIA)15 (19.2)Peripheral vascular disease25 (32.9)Coronary artery disease30 (39.5)Previous coronary revascularization20 (25.6)Renal Insufficiency (GFR <30 mL/min)5 (6.4)Connective tissue disorder2 (2.6)Previous aortic surgery31 (39.7)GFR, Glomerular filtration rate; TIA, transient ischemic attack.Values are mean ± standard deviation or number (%). Open table in a new tab