Outcomes of Staged Completion Extent II Thoracoabdominal Aortic Aneurysm Repair

Extent II thoracoabdominal aortic aneurysm (TAAA) continues to carry the highest risk for life-disabling complications, including spinal cord injury (SCI). We evaluated our outcomes of extent II TAAA repair comparing primary repair and staged completion.

We retrospectively reviewed patients who underwent primary and staged completion extent II TAAA repairs between January 1999 and September 2024. Primary repair was defined as single-stage extent II TAAA repair at initial encounter. Staged completion was defined as staged aortic repair to replace the entire extent II TAAA in continuity.

In all, 1618 patients received descending thoracic aortic aneurysm and TAAA repair. Of these, 290 patients included in the study were extent II-181 primary (62.4%) and 109 staged completion (37.6%). The extent of repairs performed to achieve the completion extent II included descending in 4.6%, extent I in 2.7%, extent II in 15.6%, extent III in 42.2%, extent IV in 32.1%, and extent V in 1.8%. Operative mortality was similar in both groups (primary, 14.4%; staged completion, 16.5%; P = .623), as was early SCI (primary, 5.0%; staged completion, 4.6%; P = .882). Delayed SCI was twice as high in primary repair compared with staged completion repair (14.9% vs 7.3%; P = .048). Respiratory failure, dialysis requirement, and stroke rates did not differ between the groups.

Outcomes after staged completion extent II TAAA repairs were comparable to those of primary extent II repairs. Staged repair significantly reduced the risk of delayed SCI.