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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
[Endovascular repair of descending thoracic aortic aneurysm: preliminary experience]
Yu-qi Wang1, Wei-guo Fu, De-bing Shi
1Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
Endovascular repair of descending thoracic aortic aneurysms (DTAA) is feasible, offering a less invasive treatment option. This initial experience shows promising results for high-risk patients, with successful stent graft deployment and aneurysm sac thrombosis.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Disease Management
Context:
- Descending thoracic aortic aneurysms (DTAA) pose significant treatment challenges.
- Traditional open repair carries high morbidity and mortality.
- Endovascular Aneurysm Repair (EVAR) offers a less invasive alternative.
Purpose:
- To present the initial clinical experience with endovascular repair of DTAA.
- To evaluate the feasibility and early outcomes of EVAR for DTAA.
- To assess complications and long-term results in a cohort of patients.
Summary:
- A retrospective analysis of 41 patients undergoing EVAR for DTAA between 2001 and 2007.
- Perioperative mortality was 4.9%, with complications including endoleaks and renal insufficiency.
- Follow-up demonstrated successful stent graft positioning, aneurysm sac thrombosis, and graft patency in most patients.
Impact:
- Endovascular repair of DTAA is feasible and associated with less trauma and quicker recovery.
- This approach may be the preferred therapy for high-risk surgical candidates.
- Further research is warranted to optimize techniques and long-term outcomes.
Objective:
To report an initial experience with the endovascular repair of descending thoracic aortic aneurysm (DTAA).
Methods:
Endoprostheses were placed into 41 patients with DTAA between January 2001 and July 2007 which were retrospectively analyzed. The preliminary right-left carotid and left carotid-subclavian bypass was performed in 4 cases in which the distances from the proximal aneurysm to the origin of the left common carotid artery were no longer than 15 mm. EVAR was conducted 1 week after the bypass or immediately.
Results:
All stent grafts were deployed in proper position. There were two deaths (4.9%) during perioperative period, resulting from multiorgan failure and acute cardiac infarction, respectively. Eighteen endoleaks occurred immediately after EVAR (43.9%), four disappeared after balloon dilatation. There were two acute renal insufficiencies (4.9%), one requiring hemodialysis for more than 30 days. Follow-up, which ranged from 1 to 60 months [median, (18.6 +/- 4.2) months] was carried out in 26 patients (63.4%). Type-I endoleak and type-III endoleak were detected in two patients in 4 years and 2 years after EVAR, might because of migration, and were corrected using another stent-graft each. Two patients died of other diseases during follow-up. Complete thrombosis of the thoracic aneurysm sac with no late migration or endoleaks was revealed on CT at 3 months postoperatively in the remaining patients. The decrease in maximal aneurysm diameter was 0-22 mm [median, (8.3 +/- 4.5) mm] and the prosthetic vascular grafts in four patients with preliminary carotid subclavian bypass surgery were patent during the follow-up period.
Conclusions:
The treatment of descending thoracic aortic aneurysm with an endovascular approach is feasible with less trauma, quick recovery and less complications. It may offer the best means of therapy for high risk patients.
