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Updated: May 15, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Thoracic endografting reduces morbidity and remodels the thoracic aorta in DeBakey III aneurysms
Bradley G Leshnower1, Wilson Y Szeto, Alberto Pochettino
1Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Thoracic endovascular aortic repair (TEVAR) offers a less invasive option for chronic DeBakey type III aortic dissection aneurysms, significantly reducing operative mortality and morbidity compared to open repair. TEVAR effectively remodels the aorta and stabilizes aneurysm size.
Area of Science:
- Cardiovascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Treatment
Background:
- Efficacy of endovascular treatment for chronic DeBakey type III aortic dissection (CD3) aneurysms is debated.
- Comparison of open versus endovascular repair for CD3 aneurysms is needed.
- Assessment of thoracic endovascular aortic repair (TEVAR) for remodeling chronically dissected thoracoabdominal aorta.
Purpose of the Study:
- To compare outcomes between open and endovascular treatment of CD3 aneurysms.
- To evaluate the efficacy of TEVAR in remodeling the thoracoabdominal aorta.
- To analyze the impact of TEVAR on true and false lumen dimensions.
Main Methods:
- Retrospective analysis of 58 patients undergoing open repair and 31 patients undergoing TEVAR for CD3 aneurysms (2005-2012).
- Subgroup analysis of TEVAR patients into CD3a (n=12) and CD3b (n=19).
- Measurement of aortic dimensions and calculation of lumen indices to assess remodeling.
Main Results:
- Open repair had 10.3% operative mortality and significant rates of pulmonary, renal failure, and paraplegia.
- TEVAR group had no operative mortality or major complications.
- TEVAR stabilized aneurysms in 87% of patients, significantly expanding the true lumen and reducing false lumen (p < 0.001).
- Thoracic false lumen thrombosis achieved in 100% of CD3a and 68% of CD3b patients.
Conclusions:
- TEVAR demonstrates reduced operative morbidity and mortality compared to open repair for CD3 aneurysms.
- TEVAR is effective in remodeling the chronically dissected thoracic aorta.
- Abdominal false lumen patency is maintained in thoracoabdominal dissection-related aneurysms.
Background:
The efficacy of endovascular treatment of aneurysms secondary to chronic DeBakey type III aortic dissection (CD3) remains controversial. The objective of this study was to compare outcomes from open and endovascular treatment of CD3 aneurysms, and to determine the efficacy of thoracic endovascular aortic repair (TEVAR) in remodeling the chronically dissected thoracoabdominal aorta.
Methods:
From 2005 to 2012, 58 patients underwent open aortic replacement (open) and 31 patients underwent endovascular therapy (TEVAR) for the treatment of CD3 aneurysms. The TEVAR patients were divided into CD3a (n = 12) or CD3b (n = 19) subgroups based upon the DeBakey classification of aortic dissection. Total aortic, true and false lumen diameters were measured at different anatomic locations. True lumen and false lumen indices were calculated to evaluate the impact of TEVAR on remodeling.
Results:
In the open group, operative mortality was 10.3% and the incidence of pulmonary failure, renal failure, and paraplegia was 13.8%, 10.3%, and 12.1%, respectively. There were no operative mortalities in TEVAR patients, and no cases of pulmonary failure, renal failure, or paraplegia. Endovascular therapy stabilized aneurysm size and remodeled the thoracic aorta in 87% of patients. The TEVAR significantly expanded the true lumen and reduced the false lumen within the stent graft in CD3a and CD3b patients (p < 0.001). Thoracic false lumen thrombosis was achieved in 100% of CD3a and in 68% of CD3b patients.
Conclusions:
In these early results, TEVAR reduces operative morbidity and mortality compared with open aortic replacement in the treatment of CD3 aneurysms. The TEVAR is effective in remodeling the chronically dissected thoracic aorta. Abdominal false lumen patency is maintained in patients with thoracoabdominal dissection-related aneurysms.
