Open aortic surgery after thoracic endovascular aortic repair

Area of Science:

• Cardiovascular Surgery
• Endovascular Interventions
• Aortic Disease Management

Background:

• Thoracic endovascular aortic aneurysm repair (TEVAR) is a less invasive alternative to open repair.
• TEVAR offers improved early outcomes, including reduced mortality and morbidity.
• Secondary interventions are common after TEVAR, with open repair being necessary in select cases.

Purpose of the Study:

• To review the literature on open repair procedures following TEVAR.
• To highlight the indications and operative strategies for open repair after TEVAR.
• To discuss the classification and outcomes of open repairs post-TEVAR.

Main Methods:

• Literature review of studies reporting open repair after TEVAR.
• Analysis of complication rates necessitating open repair (0.4–7.9%).
• Classification of open repairs: full extraction, partial extraction, or stent-graft salvage.

Main Results:

• Major complications like endoleak, fistula, infection, or device failure can necessitate open repair.
• Open repairs can be elective or emergent, depending on the complication.
• Stent-graft salvage indicates TEVAR success, unlike full or partial extraction.

Conclusions:

• Open repair remains a critical option for managing TEVAR complications.
• Understanding operative strategies is key for successful post-TEVAR open repairs.
• Careful patient selection and technique are vital for managing complex aortic conditions.