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Total endovascular treatment for extent type 1 and 5 thoracoabdominal aortic aneurysms

Gabriele Piffaretti1, Federico Fontana2, Marco Franchin1

  • 1Vascular Surgery, Department Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.

The Journal of Thoracic and Cardiovascular Surgery
|August 19, 2017
PubMed

Insights

Thoracic endovascular aortic repair (TEVAR) for thoracoabdominal aortic aneurysms involving celiac artery coverage shows good survival and low reintervention rates. However, spinal cord ischemia remains a concern, necessitating careful patient selection.

Area of Science:

  • Vascular Surgery
  • Endovascular Repair
  • Aortic Aneurysm Treatment

Background:

  • Thoracoabdominal aortic aneurysms (TAAAs) present complex treatment challenges.
  • Open repair of TAAAs carries significant morbidity and mortality.
  • Endovascular techniques offer an alternative, but landing zone limitations exist.

Purpose of the Study:

  • To evaluate the outcomes of thoracic endovascular aortic repair (TEVAR) with intentional celiac artery coverage.
  • To assess TEVAR for extent type 1 and type 5 TAAAs using a distal supramesenteric landing zone.
  • To determine survival, aortic-related mortality, and reintervention rates after this approach.

Main Methods:

  • Retrospective review of patients undergoing TEVAR for extent 1 or 5 TAAAs with celiac artery coverage.
  • Inclusion of elective or urgent cases.
  • Primary endpoints included in-hospital and follow-up survival, freedom from aortic-related mortality, and freedom from reintervention.

Main Results:

  • 100% technical success with no early mortality or visceral ischemia.
  • A 6% rate of permanent spinal cord ischemia was observed.
  • Midterm follow-up showed satisfactory survival (85% at 1 year, 49% at 5 years) and freedom from reintervention (93% at 1 and 5 years).
  • No type 1 endoleaks or distal stent-graft migration causing superior mesenteric artery occlusion were detected.

Conclusions:

  • TEVAR with intentional celiac artery coverage is a viable option for selected high-risk patients with extent 1 and 5 TAAAs.
  • While visceral ischemia was avoided, spinal cord ischemia remains a significant risk.
  • Midterm outcomes demonstrate acceptable survival and reintervention rates, comparable to open repair.
Abstract

Keywords:
celiac artery coveragespinal cord ischemiathoracoabdominal aortic aneurysm

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