[Branched stent graft for the treatment of thoracoabdominal aneurysms]

We have utilized a custom-made branched stent graft (SG) in combination with a covered stent for the treatment of thoracoabdominal aneurysms (TAAAs) that were deemed to be inoperable due to co-morbid conditions or a hostile thorax/abdomen. During the last 3 years, 121 patients with TAAAs were treated at Jikei University Hospital. Those that were deemed to be good risk (n = 43) underwent traditional surgical repair. Those in whom the TAAA was considered inoperable (n = 50) were treated with a custom-made branched SG in combination with a covered stent, while those that were considered intermediate risk (n = 29) underwent debranching bypass surgery of the visceral branches followed by stent grafting using standard SGs without fenestrations. Although patients undergoing branched SG were older and had more ischemic heart disease and chronic obstructive pulmonary disease, the surgical mortality rate, paraplegia rate, mean aneurysm size, and operative time in the endovascular TAAA group were 5%, 2.6%, 6.5 cm, and 395 min, respectively, and those in the TAAA with branched SG group were 2%, 2%, 6.5 cm, and 366 min, respectively. Six cases in the endovascular group required secondary intervention, all of which were performed percutaneously. No TAAA rupture has been encountered. Our experience has therefore confirmed that branched SG repair is feasible and safe. Further investigations with more patients are warranted.