Long-term results of hybrid endovascular repair for thoraco-abdominal aortic aneurysms☆

Abstract

The treatment of thoraco-abdominal aortic aneurysms (TAAAs) is extremely laborious, due to the surgical complexity of this condition. In particular, postoperative spinal paraplegia poses a severe complication that significantly lowers patient's quality of life. In 1997, we devised a hybrid procedure consisting of extended endovascular aortic repair (EVAR) and visceral reconstruction. In this article, we report the long-term results obtained from this procedure. We conducted 1106 endovascular aortic repairs between 1997 and 2008. Among these, we selected 86 cases of TAAA. The mean patient age was 71.6 years. Preoperative complications included 19 cases of stroke, 22 cases of coronary artery disease (CAD) and 16 cases of chronic obstructive pulmonary disease (COPD). Cerebrospinal fluid drainage was initiated during the operation. We performed bypasses from the aortic bifurcation to abdominal visceral arteries, and deployed stent grafts to exclude the entire TAAA. Operative time averaged 386 min. We lost two patients and encountered only one case of graft occlusion. Two patients had acute renal failure, but neither required a tracheostomy. Furthermore, no patients exhibited paraplegia or delayed paraplegia. We observed endoleaks in nine cases, and shrunken aneurysms in 73 cases. Long-term results included survival rates of 94.8%, 85.8%, 80.2% and 66.6% at 2, 5, 8 and 10 years, respectively. Only two patients died from aortic events. Rates of freedom from aortic events were 90.7%, 80.6%, 70.8% and 70.8% at 2, 5, 8 and 10 years, respectively. The hybrid TAAA-repair protocol yielded satisfactory results. Although thorough follow-up is required for visceral bypass, this procedure could become the standard for TAAAs.