Open thoracoabdominal aortic aneurysm repair: results from a national service

Open surgery is a durable approach to thoracoabdominal aortic aneurysm (TAAA) repair. It carries a substantial risk of major perioperative complications, including death. The aim of this study was to describe the outcomes of open repairs undertaken by the Scottish National TAAA Service since its inception 25 years ago.

Procedural details and clinical outcomes of all open TAAA repairs between 1999 and 2023 were reviewed. The primary outcome was in-hospital mortality, with secondary outcomes including overall and aneurysm-related survival, as well as rates of permanent spinal cord ischaemia (SCI), renal replacement therapy, and other major operative complications. Survival of patients requiring a thoracolaparotomy (Crawford extent I-III and V repair) versus that of patients requiring a laparotomy (Crawford extent IV repair) was assessed using Kaplan-Meier analysis.

Of 424 patients (mean(s.d.) age 65.86(10.86) years, mean(s.d.) aneurysm diameter 63.89(17.52) mm, 5.7% with a connective tissue disorder, and 72.8% male), 148 patients underwent thoracolaparotomy and 276 underwent laparotomy. While 4.5% of operations were for ruptures, most (297 (70.0%)) were for asymptomatic TAAAs. Elective and overall in-hospital mortality were 10.1% and 13.4% respectively. Patients who underwent repair requiring a thoracolaparotomy (148 patients) were younger (mean age 59.7 years versus 69.1 years; P < 0.001), had higher 30-day mortality (23.6% versus 6.5%; P < 0.001), and had a higher rate of permanent SCI (8.8% versus 0.7%; P < 0.001) compared with those who underwent repair requiring a laparotomy. Patients who underwent extent II repairs had the highest overall and elective 30-day mortality (30.2% and 26.6% respectively) and had the highest rate of permanent SCI (14.3%). The estimated overall 5-year survival was 68.3% and the estimated elective 5-year survival was 70.2%, 67.5%, and 71.3% for the entire cohort, the extent I-III and V cohort, and the extent IV cohort respectively.

Open TAAA repair is associated with significant operative risk, which varies depending on the extent of aneurysm repair.