Endovascular versus open elephant trunk completion for extensive aortic disease

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Second-stage elephant trunk completion (EC) is a critical procedure for complex aortic aneurysms.
• Comparing endovascular (EEC) and open (OEC) approaches is essential for optimizing patient outcomes.

Purpose of the Study:

• To compare the clinical outcomes between EEC and OEC for second-stage EC.
• To evaluate mortality, morbidity, and long-term survival following both approaches.

Main Methods:

• Retrospective analysis of 225 patients undergoing second-stage EC (1993-2010).
• Propensity matching was used to ensure a fair comparison between EEC (n=92) and OEC (n=133) groups.
• Outcomes assessed included 30-day mortality, major complications, survival rates, hospital stay, and reintervention rates.

Main Results:

• No significant difference in 30-day mortality, bleeding, stroke, renal failure, or spinal cord injury between EEC and OEC.
• OEC patients required tracheostomy more frequently (P=0.014).
• EEC group had significantly shorter hospital stays (P<.0001) and received less blood transfusion (P=.0001), even after matching. Reoperation rates were higher in the EEC group (28% vs 17%).

Conclusions:

• Both OEC and EEC demonstrate comparable survival and major complication rates for second-stage EC.
• EEC is associated with shorter hospital stays and reduced blood requirements, potentially expanding treatment options for older patients.
• While EEC may lead to more reinterventions, it allows for earlier completion and should not be delayed; lifelong imaging surveillance is crucial for all patients.