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| Endovascular Treatment of Thoracoabdominal Aortic Aneurysms |
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Back to 86th Annual Meeting Back to Program Outline Objective: To describe our experience with endovascular repair of thoracoabdominal aortic aneurysms (TEVAR). Methods: Between May 19, 2004 and September 30, 2005 patients with thoracoabdominal aneurysms at high risk for conventional surgical repair were enrolled in a prospective trial designed to assess the safety and efficacy of such procedures. Devices were modular, and designed to accommodate the visceral vessels. Preoperative assessment with high-resolution computed tomography was utilized to customize the devices. Mortality, procedural details, and endovascular endpoints derived from cross-sectional imaging studies and duplex ultrasound performed prior to hospital discharge and at 1, 6, and 12 months, were collected. Results: Forty-seven patients underwent TEVAR for Crawford type II or III (n=16), or type IV (n=31) thoracoabdominal aneurysms. Mean aneurysm size was 7.7cm (range 5.4 - 10.2cm) for type II/III and 6.9cm (range 4.5 - 11.2cm) for type IV aneurysms. General anesthesia was used in 43% and regional in 57% of the patients. Technically successful deployments occurred in 96% (45 of 47), without any conversions to open operations. The two technical failures included inability to stent a celiac artery (type II), which was successfully stented with a secondary procedure three days later, and the single patient that died within 24 hours of the initial procedure (type IV). Thirty day mortality was 4% (2/47). Serious complications occurred in a minority of patients and included paraplegia (4%, 2/47), new onset of dialysis dependent renal failure (2%, 1/47), prolonged ventilator support (4%, 2/47). There were no strokes. Two patients underwent re-intervention prior to hospital discharge to treat endoleaks. At follow-up, 5 endoleaks were detected that have not required re-intervention. Three late aneurysm related deaths occurred, one as a result of paraplegia, and two from chronic cardiopulmonary disease. No rupture, migration or sac growth has occurred. Conclusions: Minimally invasive repair of thoracoabdominal aneurysms in non-surgical candidates is feasible. Although complications remain a concern, the potential to offer treatment to patients previously relegated to only medical management provides a source of optimism. Further refinement of this treatment is ongoing, and will require longer follow-up. Back to 86th Annual Meeting Back to Program Outline |
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