Urgent or Emergent Endovascular Repair of Juxtarenal, Suprarenal, and Thoracoabdominal Aortic Aneurysms in Patients Unfit for Open Repair

Abstract

To evaluate the early outcomes of urgent complex endovascular repair of juxtarenal, suprarenal, and thoracoabdominal abdominal aortic aneurysms in patients medically unfit for open repair. From June 2010 to February 2011, 12 patients with juxtarenal, suprarenal, or thoracoabdominal abdominal aortic aneurysms underwent endovascular repair with adjunctive techniques at one institution. These techniques included deployment of thoracic aortic endografts above modified bifurcated abdominal aortic endografts, graft modifications, and chimney stent grafts. All patients were deemed medically unfit for open repair from cardiopulmonary standpoints. Primary end points were technical success, branch patency, presence of endoleak, and 30-day mortality. Twelve patients (5 men, 7 women) underwent urgent complex endovascular repair of symptomatic abdominal aortic aneurysmal pathology. Of these, 10 presented with suprarenal or juxtarenal abdominal aortic aneurysms, 1 with a suprarenal aortic pseudoaneurysm, and 1 with a type IV thoracoabdominal aneurysm. Five thoracic endografts were deployed in the abdominal aorta above modified bifurcated abdominal endografts. Eight graft modifications and 10 chimney stents were used to achieve seal and preserve flow to select mesenteric vessels. Technical success was achieved in 100%. At 30 days, 12 of thirteen (92%) mesenteric stent branches were patent. Two endoleaks were noted on follow-up. One of 12 patients died for a 30-day mortality of 8%. Urgent complex endovascular repair of juxtarenal, suprarenal, and thoracoabdominal abdominal aortic aneurysms can be safely and successfully performed in patients medically unfit for open repair. Mid-term and long-term results are unknown and need to be further elucidated.