Editor's Choice - Open Thoracic and Thoraco-abdominal Aortic Repair After Prior Endovascular Therapy

Paula R. Keschenau, Shirley Ketting, Barend Mees, Mohammad E. Barbati, Jochen Grommes, Alexander Gombert, Geert Willem H. Schurink, Drosos Kotelis, Michael J. Jacobs*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Web of Science)

Abstract

Objective: The aim was to present current results of open thoracic and thoraco-abdominal aortic repair as secondary procedure after prior endovascular therapy. Methods: This was a retrospective cross border single centre study. From 2006 to July 2017 45 open thoracic aortic (TAA) or thoraco-abdominal aortic aneurysm (TAAA) operations were performed on 44 patients (median age 58 [15-80] years) as secondary surgery after previous endovascular therapy comprising TEVAR (n = 38; 86%), EVAR (n = 3; 7%), fenestrated EVAR (n = 1; 2%) and TEVAR plus EVAR (n = 1; 2%). Eleven patients (25%) had had previous open aortic surgery at the secondary surgery site. Indications for TAA(A) repair were Type I endoleak (n = 10; 23%), post-dissection aneurysm progression due to persisting false lumen perfusion (n = 8; 18%), proximal/distal disease progression (n = 16; 36%), device fracture/dislocation (n = 4; 9%), infection (n = 5; 11%), and initial endograft misplacement (n = 1; 2%). The operations included descending thoracic aortic repair (n = 13, 29%), TAAA Type I (n = 4; 9%), Type II (n = 5; 11%), Type III (n = 13; 29%), Type IV (n = 7; 16%), and Type V repair (n = 3; 7%) with simultaneous arch repair in 18% (n = 8). The median time to secondary surgery was 36 (2-168) months. The median follow up was 39 (3-118) months. Results: In hospital mortality was 20% (n = 9) due to intra-operative aneurysm rupture, pneumonia induced sepsis, hemorrhagic cerebellar infarction, mesenteric ischaemia, broncho-esophageal fistula, and multiorgan failure (1/9) as well as haemorrhage (3/9). Estimated survival was 73% at 1 year and 71% overall. The most frequent complications were pneumonia (n = 19; 43%), bleeding requiring revision (n = 11; 25%) and sepsis (n = 14; 32%). Transient dialysis was required in 32% (n = 14), permanent dialysis in 6% (n = 2). Permanent spinal cord deficit (paraparesis) occurred in 6% (n = 2). Estimated freedom from aortic re-intervention was 86%. Conclusion: Open TAA(A) repair as a secondary procedure after previous endovascular aortic therapy is an important treatment option even in the endovascular era. It represents a durable treatment that can produce respectable outcomes. Yet the peri-operative morbidity and mortality are relevant and a specialised team and infrastructure are mandatory for these complex procedures. Therefore, centralisation is required. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
Original languageEnglish
Pages (from-to)57-67
Number of pages11
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume56
Issue number1
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • Thoraco-abdominal aortic aneurysm
  • Open aortic repair
  • Secondary open surgery
  • Conversion surgery
  • Endovascular aortic repair
  • TEVAR
  • EVAR
  • CONNECTIVE-TISSUE DISORDERS
  • ANEURYSM REPAIR
  • SURGICAL-CORRECTION
  • FOLLOW-UP
  • OUTCOMES
  • DISSECTION
  • INTERVENTIONS
  • MANAGEMENT
  • CONVERSION
  • SURGERY

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