Open Thoracoabdominal Aortic Procedures following Endovascular Intervention

Area of Science:

• Vascular Surgery
• Aortic Disease Management
• Endovascular Treatment Complications

Background:

• Endovascular treatment for thoracoabdominal aortic (TAA) disease can fail due to endoleak, graft issues, infection, or disease progression.
• Conversion to open surgical repair is increasingly necessary following failed endovascular interventions.
• These complex cases present significant challenges and elevated risks compared to primary open TAA repair.

Purpose of the Study:

• To highlight the necessity and challenges of open conversion for failed thoracoabdominal aortic (TAA) endovascular treatments.
• To emphasize the high morbidity and mortality associated with these procedures.
• To underscore the importance of specialized centers and experienced surgical teams.

Main Methods:

• Review of cases requiring open conversion after endovascular TAA treatment failure.
• Analysis of reasons for conversion, including endoleak, graft failure, infection, and persistent false lumen perfusion.
• Comparative assessment of outcomes versus standard open TAA repair.

Main Results:

• Open conversion surgery for TAA disease after endovascular failure is associated with high mortality and morbidity rates.
• Reasons for conversion are multifactorial, including endoleak, endograft failure, infection, and disease progression.
• Outcomes are significantly worse than primary open TAA repair.

Conclusions:

• Open conversion for failed thoracoabdominal aortic (TAA) endovascular treatment is a high-risk procedure.
• Successful outcomes depend on specialized centers, experienced surgical teams, and meticulous perioperative organ protection.
• Careful patient selection and surgical planning are critical for managing these complex aortic disease cases.