Conventional Open Repair Research Articles

Bilateral Retrovascular Femoral Hernia

A 34-year-old woman with cystic fibrosis presented with bilateral femoral hernias, which were found to be retrovascular at operation. The hernias were not amenable to conventional open or laparoscopic repair, and were repaired using pre-peritoneal mesh inserted deep to transversalis fascia. The anatomical basis and management of uncommon variants of femoral hernia are discussed.

Results of a New Surgical Paradigm: Endovascular Repair for Acute Complicated Type B Aortic Dissection

Conventional open repair of acute complicated type B aortic dissection is associated with significant morbidity and mortality. This study examined the results of thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection complicated with rupture or malperfusion syndrome. From 2004 through 2007, 35 patients (22 men) with acute complicated type B aortic dissection were treated with TEVAR. Indications included rupture in 18 (51.4%) and malperfusion syndrome in 17 (48.6%; mesenteric or renal, 5;lower extremities, 3; both, 9). Three types of endograft devices were used (mean per patient, 1.9 devices). Intravascular ultrasound imaging was used in 15 patients (42.8%). In patients with malperfusion syndrome, distal adjunct procedures to expand the true lumen included infrarenal aortic stents in 4, mesenteric/renal stents in 4, and iliofemoral stents in 7. Follow-up was 93.9% during a period of 18.3 months (range, 3 to 47 months). The mean age was 58.6 +/- 13.4 years. Technical success (coverage of the primary tear site) was achieved in 34 patients (97.1%). Coverage of the left subclavian artery was required in 25 patients (71.4%). Thirty-day mortality was 2.8%. One-year survival was 93.4% +/- 4.6%. Complications included permanent renal failure (2.8%), stroke (2.8%), spinal cord ischemia (transient [5.7%], permanent [(2.8%]), and vascular access (14.2%). The mean intensive care unit and hospital stay were 4.7 +/- 2.6 and 16.7 +/- 12.0 days, respectively. Endovascular repair of acute complicated type B aortic dissection is associated with low morbidity and mortality and has emerged as the surgical therapy of choice.

Invited Commentary

Advances in the surgical management of acute aortic dissection involving the ascending aorta have resulted in significant improvement in morbidity and mortality. However, conventional surgical technique designed to address the ascending aortic pathology often results in leaving residual dissection in the descending thoracoabdominal aorta. The management of late aneurysmal formation in the remaining distal aorta remains a clinical challenge. Even in a contemporary series, distal reoperation of thoracoabdominal aortic aneurysms in the setting of chronic dissections has been associated with perioperative mortality up to 30% [1Geirsson A. Bavaria J.E. Swarr D. et al.Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm.Ann Thorac Surg. 2007; 84: 1955-1964Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar]. Jakob and coauthors [2Jakob H. Tsagakis K. Tossios P. et al.Combining classic surgery with descending stent grafting for acute DeBakey type I dissection.Ann Thorac Surg. 2008; 86: 95-102Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar] propose a novel modification of the conventional open repair in an attempt to alter the fate of distal residual aortic dissection and possibly improve long-term outcome. The fundamental question is: “Does obliteration of the false lumen in the distal aorta (with the use of stent graft therapy) positively affect aortic remodeling and prevent aneurysmal formation?” In this series, 45 patients with acute DeBakey type I aortic dissection underwent either conventional surgery (n = 23) or hybrid repair (n = 22). The hybrid repair consists of conventional surgical repair of the ascending aortic dissection with concomitant stent graft therapy of the descending thoracic aorta. The hypothesis is that stent graft therapy of the descending thoracic aorta results in the obliteration and thrombosis of the false lumen, thus preventing aneurysmal formation of the distal thoracoabdominal aorta. The authors should be congratulated for their remarkable results on such a difficult group of patients. Their overall operative mortality was 16% (conventional surgery, 22%; hybrid, 9%; p = 0.22). Despite higher incidences of cerebral malperfusion and hemodynamic compromise in the hybrid group, there was no difference in mortality. In terms of the conduct of the operations, there was no difference in the duration of CPB, selective antegrade cerebral perfusion and deep hypothermia and circulatory arrest. Interestingly, the duration of the aortic cross clamp was shorter in the hybrid group. Postoperative results were also similar between the two groups. There was no difference in operative mortality, renal failure, stroke, and intubation time. By demonstrating no differences in the perioperative and short-term outcome between the two groups, the authors reassure us that the advances made in the proximal reconstruction and surgical outcome of ascending aortic dissection have not been compromised with this new technique. I believe this is an important point that the authors have appropriately emphasized. However, the main question of the study lies in the fate of the distal aorta (ie, aortic remodeling) after proximal reconstruction of the aortic dissection. Although early results from this study is encouraging, the study is simply too small and the follow-up too short (23 months in the hybrid group) to make definitive conclusions. Nevertheless, the fundamental concept of distal aortic remodeling in aortic dissection is an important question that should be pursued. Larger studies with long-term follow-up are needed before definitive conclusions can be made. Other issues need to be addressed and answered. Will this technique have any impact on neurologic events, such as stroke or spinal cord ischemia? What is the optimal length of coverage of the descending thoracic aorta with the endograft, as this decision must be made in considering between the effectiveness of the therapy versus the risk of spinal cord ischemia and perhaps distal malperfusion? If false lumen patency persists in the thoracic aorta despite stent graft therapy (seen in 10% patients in this study), how does that affect aortic remodeling? Also, how does the presence of a stent graft in the descending thoracic aorta affect distal reoperations? The authors demonstrated that the hybrid operation can be performed safely with no difference in mortality from the conventional surgical approach. I believe this study serves an important role in defining the concept and setting the stage for future studies. Combining Classic Surgery With Descending Stent Grafting for Acute DeBakey Type I DissectionThe Annals of Thoracic SurgeryVol. 86Issue 1PreviewTo possibly prevent late complications after classic type A aortic dissection repair, the radical concept of ascending/arch replacement with simultaneous antegrade descending stent grafting using a hybrid prosthesis was applied and compared with conventional repair leaving the distal false lumen untreated. Full-Text PDF

Symptomatic Seroma after Open Abdominal Aortic Aneurysm Repair

Seroma following open abdominal aortic aneurysm repair has rarely been described. The majority of cases in the literature have been associated with use of polytetrafluoroethylene grafts. Here, we present a patient with a very large, symptomatic periaortic graft seroma 10 years after conventional (open) repair. The etiology of such seromas is of significant interest in endovascular aortic repair.

Use of custom Dacron branch grafts for “hybrid” aortic debranching during endovascular repair of thoracic and thoracoabdominal aortic aneurysms

A significant number of patients with thoracic and thoracoabdominal aortic aneurysms are unsuitable for endovascular repair owing to the absence of graft seal zones. "Hybrid" techniques, including open aortic debranching procedures, allow creation of proximal and/or distal landing zones and expand the potential applications of endovascular repair. We report our experience with aortic arch and thoracoabdominal debranching using custom fabricated Dacron branch grafts, which greatly simplify aortic debranching by providing inflow via a single anastomosis and incorporate a side arm for introduction of the stent graft. Between November 14, 2005, and December 18, 2006, a total of 53 thoracic endograft procedures were performed at our institution. Of these, 13 (25%) involved either open aortic arch or abdominal debranching to create proximal or distal landing zones for endovascular repair. Patients undergoing arch debranching (n = 7) had aneurysms involving the transverse arch with less than 2 cm of proximal landing zone distal to the innominate artery, necessitating stent graft coverage of both the innominate and left common carotid arteries. Patients undergoing complete abdominal debranching (n = 6) had either thoracoabdominal aortic aneurysms (extent II, n = 1; extent V, n = 3) or visceral button false aneurysms after prior open thoracoabdominal aortic aneurysm repair (n = 2). In all cases, endovascular aneurysm exclusion was performed at the same operation. Mean patient age was 63 +/- 11 years (range 46-83 years); all patients had significant comorbidities, including prior open aortic surgery in 8 (62%). There were no perioperative (30 day) deaths and no permanent neurologic deficits, either cerebrovascular accident or paraparesis/paraplegia. At a mean follow-up of 7.5 +/- 6.0 months, there has been no late mortality and all debranching bypass grafts remain patent without need for further intervention. Computed tomographic scans demonstrate no type I or III endoleaks, and all aneurysms are thrombosed with stable (n = 4) or decreasing aortic dimensions (n = 9). "Hybrid" aortic debranching using custom fabricated Dacron branch grafts with a single inflow source combined with endovascular aneurysm exclusion appears to be a safe alternative to conventional open repair for thoracoabdominal and arch aneurysms and avoids the need for cardiopulmonary bypass and aortic crossclamping. This technique may be ideally suited to patients with significant comorbidity or prior open aortic surgery. Longer term follow-up is needed to determine the durability of this approach.

Thoracoscopic repair of tracheoesophageal fistulas: a case–control matched study

IntroductionTo date, there is no comparative study of thoracoscopic repair (TR) vs conventional open repair (COR) for tracheoesophageal fistula (TEF). The aim of the study was to compare the 2 techniques in neonates with TEF. MethodsA multi-institutional case-control study of cases of TEF was undertaken. The minimum follow-up was 6 months. Patients were considered for TR based on surgeon's preference. Cases were frequency matched on a 1:1 ratio based on gestational age and weight. Outcomes of interest were operative time, postoperative leaks, and postoperative stricture development. Statistical analysis using univariate analysis was performed. ResultsTwenty-three neonates underwent TR. There were no differences between TR and COR groups with regard to weight and gestational age. The distribution of associated anomalies was similar in both groups. The mean operative time was 149.4 and 179 minutes in TR and COR, respectively (P = .18). Three patients were converted to COR. There were 4 leaks in TR and 3 in COR (P = .728). Inversely, 2 patients in the TR group developed a stricture necessitating dilation as compared with 4 patients in the COR group (P = .414). ConclusionThoracoscopic repair of TEF is safe and comparable with conventional open repair.

Hybrid Thoracic Stent Graft Repair of a Complex Type B Aortic Dissection in a Patient who Presented Three Weeks after Repair of a Type a Aortic Dissection

Long-term management after repair of a type A aortic dissection includes aggressive medical therapy and routine surveillance with serial imaging to ensure thrombosis of the false lumen. Retained patency of the false lumen can lead to either the development of a false lumen aneurysm with a subsequent rupture or extension of dissection. Typically such events occur late, usually months after repair, and are treated with either a conventional one-stage open thoracoabdominal repair or a two-stage "elephant trunk" procedure. However, most patients who undergo such procedures experience major complications and the procedure-related mortality rate is high. We present a unique case of a 61-year-old woman who presented with a ruptured type B aortic dissection 3 weeks after repair of a type A aortic dissection. She underwent an emergent thoracotomy and primary repair of the ruptured aorta followed by concomitant arch debranching and thoracic stent graft placement. Simultaneous surgical debranching with a median sternotomy and endovascular repair with stent grafts is an attractive hybrid approach in patients who present with an acute rupture of a false lumen aneurysm soon after initial repair of an aortic dissection, a situation in which a conventional repair is not feasible. This report emphasizes that hybrid thoracic stent graft repair should be considered for such high-risk patients in the near future as it offers them relatively lower morbidity and mortality compared with what is seen with conventional repairs.

Great Vessel and Cardiac Trauma: Diagnostic and Management Strategies

Blunt and penetrating trauma to the chest can result in great vessel or cardiac injury. Both the diagnosis and management of these thoracic injuries have evolved from more invasive to less invasive strategies paralleling the advent of sophisticated imaging tools and the development of endovascular therapies. Despite these advances, conventional open repair and reconstruction techniques remain important and are often the definitive means toward effective management of these severely injured patients. The following review outlines the historical perspective, diagnosis, and management of blunt thoracic aortic, blunt cardiac, and penetrating cardiac injuries.

Tips for Successful Outcomes for Descending Thoracic and Thoracoabdominal Aortic Aneurysm Procedures

The continuing evolution of endovascular approaches to the repair of descending thoracic and thoracoabdominal aortic aneurysms necessitates careful evaluation of the safety and efficacy of these alternative therapies as they compare to the "gold standard" of open surgical repair. The purpose of this report is to present our approach to conventional open surgical repair of these aneurysms. Routine surgical modalities include use of moderate systemic heparinization, mild permissive hypothermia, and sequential aortic clamping. For extensive thoracoabdominal and select descending aortic procedures, additional modalities are used. The multimodal approach to organ protection during surgical treatment of descending thoracic and thoracoabdominal aneurysms has evolved substantially over the past 20 years. Experienced surgical centers now have much lower mortality and morbidity rates for these operations than previously reported. Current management strategies enable patients to undergo conventional open aneurysm repairs with excellent early survival and acceptable morbidity.

Hybrid Laparorobotic Debranching and Endovascular Repair of Thoracoabdominal Aortic Aneurysm

Surgical debranching and endovascular repair is an attractive hybrid approach in high-risk patients with thoracoabdominal aneurysms unsuitable for conventional open repair. Vascular laparorobotic technology is an evolving field in the treatment of aortoiliac and aneurysmal disease. Herein we present a case in which hybrid laparorobotic debranching and endovascular repair was performed in a patient with a symptomatic 7 cm thoracoabdominal aortic aneurysm extent III. The laparorobotic approach was utilized for iliac artery exposure and suturing of the proximal anastomosis of the debranching graft. The technique was also useful in limiting the extent of the abdominal incision in a patient with severe comorbidities. Advantages of computer-assisted robotic vascular reconstruction include a high-resolution three-dimensional field of view and technical precision for vascular dissection and anastomosis.

The Glasgow Aneurysm Score as a tool to predict 30-day and 2-year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial

Randomized trials have shown that endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) has a lower perioperative mortality than conventional open repair (OR). However, this initial survival advantage disappears after 1 year. To make EVAR cost-effective, patient selection should be improved. The Glasgow Aneurysm Score (GAS) estimates preoperative risk profiles that predict perioperative outcomes after OR. It was recently shown to predict perioperative and long-term mortality after EVAR as well. Here, we applied the GAS to patients from the Dutch Randomized Endovascular Aneurysm Repair (DREAM) trial and compared the applicability of the GAS between open repair and EVAR. A multicenter, randomized trial was conducted to compare OR with EVAR in 345 AAA patients. The GAS was calculated (age + [7 points for myocardial disease] + [10 points for cerebrovascular disease] + [14 points for renal disease]). Optimal cutoff values were determined, and test characteristics for 30-day and 2-year mortality were computed. The mean GAS was 74.7 +/- 9.3 for OR patients and 75.9 +/- 9.7 for EVAR patients. Two EVAR patients and eight OR patients died < or =30 days postoperatively. The area under the receiver-operator characteristic curve (AUC) was 0.79 for OR patients and 0.87 for EVAR patients. The optimal GAS cutoff value was 75.5 for OR and 86.5 for EVAR. By 2 years postoperatively, 18 patients had died in both the EVAR and the OR patient groups. The AUC was 0.74 for OR patients and 0.78 for EVAR patients. The optimal GAS cutoff value was 74.5 for OR and 77.5 for EVAR. This is the first evaluation of the GAS in a randomized trial comparing AAA patients treated with OR and EVAR. The GAS can be used for prediction of 30-day and 2-year mortality in both OR and EVAR, but in patients that are suitable for both procedures, it is a better predictor for EVAR than for OR patients. In this study, the GAS was most valuable in identifying low-risk patients but not very useful for the identification of the small number of high-risk patients.

Endovascular Repair of an Ascending Aortic Pseudoaneurysm With a Septal Occluder Device: Mid-Term Follow-Up

Ascending pseudoaneurysm is an infrequent complication of ascending aortic surgery. Redo operations are often associated with a high surgical morbidity and mortality. Endovascular management of ascending aortic pathologies with endoluminal graft therapies are challenging due to short landing zones and the fear of flow obstruction to the coronaries and brachiocephalic circulation. We report mid-term follow-up of the management of an ascending aortic pseudoaneurysm using a an Amplatz septal occluder (AGA Medical Corp, Golden Valley, MN) in a 51-year-old man considered at high risk for conventional open surgical repair.

Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms: Results of a randomized trial

Two randomized trials have shown similar mid-term outcomes for survival and quality of life after endovascular and conventional open repair of abdominal aortic aneurysms (AAA). With reduced hospital and intensive care stay, endovascular repair has been hypothesized to be more efficient than open repair. The Dutch Randomized Endovascular Aneurysm Management (DREAM) trial was undertaken to assess the balance of costs and effects of endovascular vs open aneurysm repair. We conducted a multicenter, randomized trial comparing endovascular repair with open repair in 351 patients with an AAA and studied costs, cost-effectiveness, and clinical outcome 1 year after surgery. In addition to clinical outcome, costs and quality of life were recorded up to 1 year in 170 patients in the endovascular repair group and in 170 in the open repair group. Incremental cost-effectiveness ratios were estimated for cost per life-year, event-free life-year, and quality adjusted life-year (QALY) gained. Uncertainty regarding these outcomes was assessed using bootstrapping. Patients in the endovascular repair group experienced 0.72 QALY vs 0.73 in the open repair group (absolute difference, 0.01; 95% confidence interval [CI], -0.038 to 0.058). Endovascular repair was associated with additional euro 4293 direct costs (euro 18,179 vs euro 13.886; 95% CI, euro 2,770 to euro 5,830). Most of the bootstrap estimates indicated that endovascular repair resulted in slightly longer overall and event-free survival associated with respective incremental cost-effectiveness ratios of euro76,100 and euro 171,500 per year gained. Open repair appeared the dominant strategy in costs per QALY. Presently, routine use of endovascular repair in patients also eligible for open repair does not result in a QALY gain at 1 year postoperatively, provides only a marginal overall survival benefit, and is associated with a substantial, if not prohibitive, increase in costs.

Endovascular Treatment of Visceral Artery Aneurysms

Visceral artery aneurysms, although uncommon, can present with life-threatening hemorrhage. The increasing use of imaging studies has allowed for earlier identification and intervention of these aneurysms, thus avoiding the high morbidity and mortality associated with rupture. The treatment options for visceral artery aneurysms range from conventional open surgical repair to minimally invasive techniques using covered stents or embolization materials. Anatomic features and patient selection determine which treatment option would result in the most durable treatment and outcome. This article reviews our experience with the endovascular treatment of visceral artery aneurysms.

Laparoscopic Repair of Peptic Ulcer Perforation Without Omental Patch Versus Conventional Open Repair

Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. Nevertheless, most studies have shown that the disadvantages of the laparoscopic treatment of peptic ulcers are a long operation time, a high reoperation rate, and a need for an experienced surgeon. Thus, the objective of the current study was to compare the safety and efficacy of optimized laparoscopic surgery without an omental patch for a perforated peptic ulcer within a shorter operational time with conventional open surgery in a 4-year period. From May 2002 to June 2006, 35 consecutive patients with a clinical diagnosis of a perforated peptic ulcer were prepared prospectively to undergo either an open or optimized laparoscopic surgery. Seventeen patients with a perforated peptic ulcer underwent simple laparoscopic repair without an omental patch. Three patients (17.6%) who were begun by the laparoscopic approach had to be converted to open surgery. Eighteen patients underwent conventional open surgery. The mean operative time for laparoscopic repair was 42.10 minutes (range, 35-60), which was significantly shorter than the 55.83 minutes for open repair (range, 35-72; P = 0.001). Postoperative parenteral analgesic requirements were lower after laparoscopic repair (75.0 mg) than that after an open repair procedure (101.39 mg; P = 0.02). There was no statistically significant difference between the procedures in terms of hospital stay (5 vs. 5.33 days; P = 0.37) and the timing of access to normal daily activity (6.8 vs. 7.1 days) (P = 0.54). Laparoscopic surgery, when optimized by a simple repair without an omental patch and 10 mm of a large-channel aspirator-irrigator, may be safely and effectively applied to the patients with small duodenal perforated peptic ulcers (<10 mm) and because of its having low risk factors. The procedure may be an alternative treatment to other procedures when in experienced hands.

Emergency repair of traumatic aortic rupture: Endovascular versus conventional open repair

Our objective was to compare early results of endovascular stenting for traumatic aortic rupture with conventional open repair. We conducted a retrospective review of consecutive cases of traumatic aortic rupture in a single institution from July 2000 to July 2006. Fifteen cases were identified. The mean injury severity score was 43 +/- 10. Fourteen patients had the procedure within 24 hours of admission to the hospital. Seven patients underwent endovascular stenting and 8 underwent open repair. For endovascular stenting, there were no failed procedures, no periprocedural complications, and no periprocedural deaths. In 6 patients, there was no evidence of endoleak, stent migration, or late pseudoaneurysm formation. One patient required a second stent 2 years later to treat a stenosis in the original stent. For open repair, cardiopulmonary bypass was used in 7 of the 8 patients. Lower limb paraplegia developed postoperatively in 1 patient and another patient died of head injuries. There was a significant reduction in the mean duration of the procedure (2.2 +/- 0.90 vs 5 +/- 3.2 hours; P = 0.04), the mean intraoperative blood loss (311 +/- 20 vs 953 +/- 20 mL; P = .02), the mean number of units of blood and blood products used (0.43 +/- 1.1 vs 3 +/- 3 units; P = .026), and the mean dose of heparin required (5000 +/- 1700 vs 24,000 +/- 7500 IU; P = .001) in the endovascular stenting group. There was no difference in duration of ventilation, intensive treatment unit, or hospital stay. Endovascular stenting is technically feasible and applicable to a range of cardiac patients. It takes less time than open repair, requires less heparin and blood products, and therefore simplifies management of other injuries. In hemodynamically stable patients, endovascular stenting is the treatment of choice for traumatic aortic rupture.

Endovascular Ruptured Abdominal Aortic Aneurysm Repair (EVRAR): A Systematic Review

To review evidence supporting the use of endovascular ruptured aneurysm repair (EVRAR) for treatment of ruptured abdominal aortic aneurysm (RAAA). A systematic review of the medical literature was performed for relevant studies. We searched a number of electronic databases and hand-searched relevant journals until November 2006 to identify studies for inclusion. We considered studies in which patients with a confirmed ruptured abdominal aortic aneurysm were treated with EVRAR, which reported endpoints of mortality and major complications. There was 1 randomised controlled trial (RCT), 33 non-randomised case series (24 retrospective and 9 prospective) reports were identified comparing EVRAR (n=891) with conventional open surgical repair for the treatment of RAAA. Whilst no benefit in the primary outcome of mortality was noted in the only RCT, evidence from non-randomised studies suggest that EVRAR is feasible in selected patients, where it may be associated with a trend towards reductions in blood loss, duration of intensive care treatment, early complications, and mortality. For the treatment of symptomatic or ruptured abdominal aortic aneurysm, emergency endovascular repair (EVRAR) is feasible in selected patients, with early outcomes comparable to best conventional open surgical repair for the treatment of RAAA.

Impact of Randomized Trials Comparing Conventional and Endovascular Abdominal Aortic Aneurysm Repair on Clinical Practice

To report a retrospective study into the effects of trials on clinical decision-making regarding abdominal aortic aneurysm (AAA) patients suitable for both conventional open (OR) and endovascular aneurysm repair (EVAR). A questionnaire was sent to 1400 Dutch surgeons and trainees. Interviewees had to choose between OR and EVAR for AAA patients with and without comorbidity. Specifically, their preferences before and after the publication of 2 randomized trials (EVAR-1 and DREAM) were polled. Of the 524 (37%) questionnaires returned, 223 (43%) respondents treated AAA patients. Before publication of the trials, 160 (72%) preferred OR for the patient without comorbidity and 169 (76%) preferred EVAR for the patient with comorbidity. In total, 72 (32%) respondents changed their preference after the trials were published; however, there was no overall major shift. Focusing on the different cases revealed that the OR preference was significantly enhanced for the patient without comorbidity (p<0.01), while the EVAR preference was significantly enhanced for the patient with comorbidity (p<0.05). The randomized trials have not induced major overall changes in surgical decision-making for AAA patients suitable for both EVAR and OR.

Conventional Open Repair of Descending Thoracic Aortic Aneurysms

Conventional open reconstruction of the descending thoracic aorta is a safe and effective therapy for the management of aneurysms and is the standard by which all other therapies should be compared. Advances in surgical techniques, circulation management, neurocerebral protection, anesthesia, and postoperative management have contributed to significant reductions in morbidity and mortality over the past 50 years. More recently, endovascular stent grafting has begun to supplant conventional open repair based on its ease of performance and a perception of reduced morbidity and mortality. In reality, when carefully compared, differences in primary outcomes (mortality, stroke rate, and paraplegia) between open repair and endovascular repair are not so clear, and the long-term durability of endovascular repairs is not yet known. Open descending thoracic aortic repair still has an important role in the management of descending thoracic aortic disease in the current era.

Commentary on "Conventional Open Repair of Descending Thoracic Aortic Aneurysms"

Commentary on "Conventional Open Repair of Descending Thoracic Aortic Aneurysms"