Total Endovascular Repair of Contained Ruptured Thoracoabdominal Aortic Aneurysms

Abstract

To report perioperative and 1-year results of total endovascular repair of contained ruptured thoracoabdominal aortic aneurysms (TAAAs). Between 2015 and 2017, preoperative, procedural, and postoperative data of patients with radiographic evidence of contained ruptured TAAAs treated by endovascular repair were prospectively collected. Only patients with stable hemodynamic parameters were enclosed. Primary endpoints were 30-day/in-hospital mortality, spinal cord ischemia (SCI), postoperative cardiopulmonary complications, and new onset of hemodialysis. Secondary endpoints were endoleaks, reinterventions, and overall follow-up survival. Twelve patients underwent endovascular repair for contained ruptured TAAAs. According with the Crawford/Safi's classification, 6 type II (50%), 3 type III (25%), 1 type IV (8%), and 2 type V (17%) TAAAs were treated. All patients were symptomatic. Overall, 34 target visceral vessels were planned to be revascularized. The mean time from admission to treatment was 48hours (range 4-96), with 4 patients operated within 24hours. Five patients (42%) were treated by T-branch, 3 (25%) by custom-made fenestrated/branched endografts, 3 (25%) by parallel graft technique, and 1 (8%) by standard thoracic endovascular aortic repair covering a stenotic celiac trunk. The 30-day and in-hospital mortality was 17% and 25%, respectively. Two patients (17%) developed SCI. Cardiac and pulmonary complications were reported in 1 (8%) and 3 (25%) cases, respectively. One patient (8%) needed permanent hemodialysis. Two endoleaks (17%) were detected at the postoperative computed tomography angiography (1 low-flow gutter endoleak and 1 type III endoleak). Four patients (33%) required re-interventions within 30 postoperative days. The mean follow-up was 12months (range 1-22). No late target visceral vessels occlusion, endoleak, or reintervention occurred in this series. Overall, 7/12 (59%) patients were alive, and no cases of TAAA-related mortality occurred during follow-up. According to our results, endovascular repair of contained ruptured TAAAs is feasible by a flexible approach in selected patients with anatomical suitability and stable hemodynamic conditions. Although early mortality and morbidity are significant, with frequent reintervention necessity, subsequent follow-up is free from reinterventions and TAAA-related mortality.