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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
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Treatment of thoracoabdominal aortic disease in patients with connective tissue disorders
Natalia O Glebova1, Duke E Cameron2, James H Black3
1Mid-Atlantic Permanente Medical Group, Rockville, Md.
Insights
Open repair, particularly branched graft techniques, remains the standard for treating aortic aneurysms in connective tissue disorders (CTDs). Endovascular repair shows higher complication rates and need for reintervention in CTD patients.
Area of Science:
- Cardiovascular Surgery
- Genetics and Genomics
- Vascular Medicine
Background:
- Aneurysmal degeneration of the aorta is prevalent in connective tissue disorders (CTDs).
- Treatment options for these aneurysms include open and endovascular repair.
- Evidence for optimal treatment strategies in CTD patients is limited.
Purpose of the Study:
- To review existing evidence on open and endovascular repair for thoracoabdominal aortic disease in patients with CTDs.
- To compare outcomes and complications associated with different aortic repair approaches in this specific patient population.
Main Methods:
- Systematic literature review of PubMed and referenced manuscripts.
- Inclusion of studies on open and endovascular treatment of thoracoabdominal aortic aneurysms and dissections in CTD patients.
- Analysis of 28 identified studies reporting on repair outcomes.
Main Results:
- Open repair demonstrated low perioperative morbidity and mortality, good branch patency, and infrequent reintervention.
- Endovascular repair was associated with significant endograft-related complications and a substantial need for secondary interventions or open conversions.
- Open branched graft repair emerged as a preferred technique.
Conclusions:
- High-quality comparative evidence for aortic repair in CTDs is lacking.
- Endovascular interventions in CTD patients are linked to short- and long-term device- and aorta-related complications.
- Open repair, especially branched graft repair, is considered the current standard of care for aortic disease in CTDs, with endovascular options reserved for select cases.
Objective:
Aneurysmal degeneration of the entire aorta is common in patients with connective tissue disorders (CTDs). Potential treatment options of these aneurysms include open repair and endovascular repair. Our objective herein was to review available evidence for different approaches to treatment of thoracoabdominal aortic disease in patients with CTDs.
Methods:
We performed a systematic literature review using PubMed and referenced manuscripts on open and endovascular treatment of thoracoabdominal aortic aneurysms and dissections in patients with CTDs.
Results:
A total of 28 studies were identified for inclusion in this review, 8 reporting on outcomes after open thoracoabdominal aortic aneurysm repair in patients with CTD, 8 on open branched graft use, and 12 on endovascular aortic repair in this population of patients. Reported outcomes were characterized by low perioperative morbidity and mortality, good branch patency, and low rate of reintervention for open repair and significant rates of endograft-related complications and substantial need for secondary endovascular interventions and open conversions for endovascular repair.
Conclusions:
There is a lack of high-quality evidence to support any particular approach to aortic repair in patients with CTD and a dearth of comparative data between open repair and endovascular repair. There are distinct differences in the published lengths of follow-up between the two repair approaches as well as in the prevalence of their use in an acute vs elective setting. It is evident that endovascular interventions for aortic disease in patients with CTDs are associated with many device- and aorta-related complications both in the short term and in the long term. Despite the lack of level 1 evidence, open repair currently remains the standard approach to treatment of aortic disease due to CTDs. Open branched graft repair in particular is the preferred technique. Endovascular interventions may be cautiously used in patients with CTDs in selective circumstances.
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