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| Abdominal Debranching with Thoracic Endografting for the Treatment of Thoraco-abdominal Aneurysm in 21 Consecutive Patients | |
Jacques Kpodonu1, Venkatesh Ramaiah2, Grayson H. Wheatley2, Julio Rodriguez-Lopez2, David Caparrelli2, Rame Iberdemaj2, Edward B. Diethrich2; 1Hoag Memorial Presbyterian, NewportBeach, CA; 2Arizona Heart Institute, Phoenix, AZ
Methods: Twenty-one consecutive patients(11 males and 10 females) with mean age 70 years range (35-93) underwent hybrid surgical reconstructions for complex thoraco abdominal aneurysms over a 24 month period (March 2005-March 2007). Elective repair was performed on 20 patients with 6 patients having prior aortic surgery. Mean proximal neck, distal neck and aortic sac diameter were 30.3mm, 23 mm and 6.7cm respectively. Hybrid repair was performed on Crawford type 1 n=1,Crawford type II n=3,Crawford type III n=7,Crawford type IV n=4,Crawford Type V n=6. Endograft deployment was transfemorally n=13 and dacron conduit graft n=8 using standardized endovascular techniques. Inflow conduit was descending thoracic aorta n=10, aorta bifemoral graft n=3, tube graft n=3, right iliac artery n=4, left iliac artery n=1. Procedure was staged in 3 patients. Outcome variables including treatment failures (endoleak, aortic rupture, reintenvention) or aortic related deaths were assessed. Follow-up included clinical examination, chest and abdominalradiographic,CT scan at discharge, 6 months, 1 year and yearly thereafter. Results: Patient demographics included hypertension (100%),coronary artery disease(64%),peripheral vascular disease (100%),diabetes(7%) ,obesity(21%),chronic obstructive lung disease(78%)renal insufficiency (28.6%). Mean operating time and blood loss were 4.25 hours and 0.9L respectively. Debranched vessels included right renal n=15, left renal n=16, celiac n=15 superior mesenteric n=18. One endograft was deployed in 9 patients and 2 endografts in 12 patients.30 day mortality was 5.7% (n=1/21) from complications relating to surgery. At follow up 1.5%(n=1/64) vessel(renal) was lost. Complications included transient left extremity weakness n=1, renal insufficiency requiring hemodialysis n=2, lower limb ischemia n=2, mesenteric ischemia n=1and respiratory failure n=2. distal type I endoleak n=1, There was no peri operative myocardial infarction, paraplegia, graft migration, graft collapse or aortic rupture. Conclusion: Repair of complex thoraco abdominal aneurysms using a hybrid technique is safe in an elderly and high risk population of patients at short term. Long term data regarding the hybrid techniques remain to be determined. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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