Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization

Area of Science:

• Vascular Surgery
• Endovascular Techniques
• Aortic Aneurysm Repair

Background:

• Complex thoracoabdominal aneurysms (TAAs) pose significant surgical challenges.
• Traditional open repair is associated with high morbidity and mortality.
• The visceral hybrid stent-graft offers a less invasive approach.

Purpose of the Study:

• To evaluate the early outcomes of transabdominal stent repair for complex TAAs (Crawford types I, II, and III).
• To assess the efficacy of surgical revascularization of visceral and renal arteries during stent repair.
• To compare the hybrid stent-graft procedure with open surgical repair for TAAs.

Main Methods:

• Retrospective review of prospectively collected data from 29 consecutive patients undergoing visceral hybrid procedures.
• Analysis of patient demographics, aneurysm types, comorbidities, and procedural details.
• Assessment of perioperative outcomes, including mortality, complications, and graft patency.

Main Results:

• 90% of patients (26/29) completed the procedure, with no paraplegia within 30 days or during hospitalization.
• Elective and urgent mortality was 13%; all ruptured aneurysm patients died within 30 days.
• Major complications included prolonged respiratory support, renal impairment, and ischemic events. Graft patency was high (92% at median 8 months).

Conclusions:

• Visceral hybrid stent-grafts show encouraging early results for Crawford type I, II, and III TAAs.
• The procedure offers a safe and effective alternative to open surgery in high-risk patients.
• No paraplegia was observed, supporting the adoption of this technique for specific TAA cases.