Related Experiment Video
Updated: Jun 25, 2026
06:26
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Evolution in the management of the total thoracic aorta
Tad Kim1, Tomas D Martin, W Anthony Lee
1Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida 32610-0286, USA.
The Journal of Thoracic and Cardiovascular Surgery
|March 5, 2009
Summary
This study found that using thoracic endovascular aortic repair (TEVAR) to complete the second stage of elephant trunk procedures for extensive thoracic aortic aneurysms leads to higher completion rates and shorter hospital stays. TEVAR is a safe and feasible option for hybrid aortic aneurysm repair.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Aneurysm Repair
- Endovascular Interventions
Background:
- Extensive thoracic aortic aneurysms traditionally treated with 2-stage elephant trunk procedures.
- Single-stage repairs are sometimes incomplete due to complications or complexity.
- Endovascular stent grafts are increasingly used for second-stage completion since 2006.
Purpose of the Study:
- To compare outcomes of 2-stage elephant trunk repair (surgical vs. endovascular completion) versus single-stage transmediastinal repair for extensive thoracic aortic aneurysms.
- To evaluate the efficacy and safety of hybrid endovascular repairs in this patient cohort.
Main Methods:
- Retrospective cohort study of 103 patients with extensive thoracic aortic aneurysms (1992-2007).
- Patients underwent 2-stage elephant trunk repair with either open surgical (OPEN) or thoracic endovascular aortic repair (TEVAR) completion, or single-stage (SS) repair.
- Outcomes were analyzed comparing the different surgical approaches.
Main Results:
- Higher completion rates were observed with TEVAR compared to OPEN completion (78% vs. 47%, P = .01).
- TEVAR patients experienced shorter second-stage hospital stays (5.5 vs. 16.5 days), fewer transfusions, and less acute kidney injury.
- No significant differences in mortality, paraplegia, or stroke were found between groups; 6-month survival estimates favored TEVAR (78% vs. 64%).
Conclusions:
- Thoracic endovascular aortic repair (TEVAR) significantly improves the completion rate of the second stage in elephant trunk procedures.
- Hybrid repair using TEVAR offers benefits including reduced hospital stay and fewer transfusions for extensive thoracic aortic aneurysms.
- TEVAR is a feasible and safe component in the hybrid management of complex thoracic aortic aneurysms.
Related Concept Videos
01:15Thoracic Aorta
The thoracic section of the aorta begins at the T5 vertebra and extends to the T12 level at the diaphragm, initially progressing through the mediastinum to the left of the spinal column. Throughout its course in the thoracic segment, the thoracic aorta emits various offshoots known collectively as visceral and parietal branches. The branches that predominantly supply blood to visceral organs are termed visceral branches and include bronchial, pericardial, esophageal, and mediastinal arteries,...
01:26Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
01:25Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
01:14The Aorta
The aorta is the largest artery in the human body. It originates from the left ventricle of the heart and extends down to the abdomen, where it splits into two smaller arteries. Structurally, it can be divided into four main parts: the ascending aorta, the aortic arch, the thoracic aorta, and the abdominal aorta.
The average diameter of the aorta is approximately 2-3 cm, but the size can vary depending on the section of the aorta and the individual's age, sex, and body size. The aorta is...
The average diameter of the aorta is approximately 2-3 cm, but the size can vary depending on the section of the aorta and the individual's age, sex, and body size. The aorta is...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...