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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Branched endografts for thoracoabdominal aneurysms
Roy Greenberg1, Matthew Eagleton, Tara Mastracci
1Departments of Vascular Surgery, Cardiothoracic Surgery, Radiology, and Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio, USA. greenbr@ccf.org
The Journal of Thoracic and Cardiovascular Surgery
|November 25, 2010
Summary
Endovascular repair of thoracoabdominal aneurysms shows promising intermediate-term results, with survival and patency comparable to surgical repair. While technically feasible, risks of mortality and spinal cord ischemia persist.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Repair
Background:
- Endovascular management of thoracoabdominal aneurysms has advanced significantly since 2001, enabling treatment of complex anatomies.
- Despite technological progress, widespread adoption requires a deeper understanding of engineering, imaging, and device principles.
Purpose of the Study:
- To evaluate the technical feasibility and intermediate-term outcomes of endovascular repair (ER) for thoracoabdominal and juxtarenal aneurysms.
- To compare ER outcomes with contemporary surgical repair (SR) in terms of mortality and paraplegia risk.
Main Methods:
- Utilized reinforced fenestrated branches with balloon-expandable stent grafts and side-arm branches with self-expanding stent grafts.
- Employed intraoperative fusion techniques combining preoperative CT data with intraoperative fluoroscopy since 2009.
- Assessed long-term survival using life table analysis and log rank tests; intermediate-term patency and paraplegia data were previously published.
Main Results:
- Enrolled 406 patients with thoracoabdominal aneurysms and 227 with juxtarenal aneurysms.
- Reported 2-year survival rates ranging from 74% to 82% based on aneurysm type.
- Found similar 30-day and 12-month mortality between ER and SR groups (5.7% vs 8.3% at 30 days; 15.6% vs 15.9% at 12 months).
- Observed comparable paraplegia risk between ER and SR (4.3% vs 7.5%).
- Achieved 97.8% patency for reinforced fenestrated branches at 15 months; side-arm branch occlusion was rare (1 case).
- Reduced contrast dose by over 50% with new imaging tools.
Conclusions:
- Endovascular repair of thoracoabdominal aneurysms is technically feasible with promising intermediate-term results, particularly for high-risk surgical candidates.
- Excellent intermediate-term patency and survival rates were observed, with rare late ruptures.
- Mortality and spinal cord ischemia remain considerable risks associated with endovascular repair.
