[Open thoracic and thoracoabdominal aortic repair vs. f/bTEVAR - complementary or competitive?]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Open repair (OR) for thoracic and thoracoabdominal aortic pathologies is increasingly outnumbered by fenestrated/branched (thoracic) endovascular aortic repair (f/b[T]EVAR).
• OR for complex cases demands specialized surgical infrastructure and significant expertise.
• Specific OR expertise remains crucial for indications like young patients, connective tissue disorders, and aortic graft infections.

Purpose of the Study:

• To compare the necessity and outcomes of open repair (OR) versus fenestrated/branched (thoracic) endovascular aortic repair (f/b[T]EVAR) for complex aortic pathologies.
• To highlight the continued relevance of OR in specialized aortic centers.

Main Methods:

• Review of current practices and outcomes for OR and f/b[T]EVAR.
• Analysis of short-term, mid-term, and long-term results, including complications and re-intervention rates.
• Consideration of specific patient populations and indications for each approach.

Main Results:

• f/b[T]EVAR shows superior short- and mid-term outcomes, including shorter hospital stays and less invasive procedures.
• OR demonstrates better long-term results regarding overall mortality, re-intervention rates, and secondary complications.
• Minimizing OR complications requires advanced techniques like cerebrospinal-spinal fluid drainage and specific perfusion strategies.

Conclusions:

• OR is a vital service for dedicated aortic centers, particularly for specific patient groups.
• While f/b[T]EVAR dominates current practice, OR's long-term benefits suggest its continued necessity and potential resurgence.