Debate regarding the best surgical option for type IV thoracoabdominal aortic aneurysms.

Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (Impact Factor: 2.98). 07/2011; 54(1):258-67. DOI: 10.1016/j.jvs.2011.05.024
Source: PubMed

ABSTRACT Conventional open surgical repair, endovascular treatment, and the hybrid technique constitute the three treatment options for patients with type IV thoracoabdominal aortic aneurysms (TAAAs). Treatment is advocated to prevent rupture but yields significant risk for spinal cord ischemia, cardiovascular, and renal and respiratory complications, including death. Refinements in open surgical techniques and branched endovascular graft repair together with the development of hybrid techniques have been applied to the treatment of type IV-TAAAs to decrease the risk of these complications. However, much of the evidence of the argument is circumstantial. Large experiences are limited to a few centers worldwide with inherent disparity between patient groups and several limitations to the construction of a prospective randomized trial. This controversial subject is now open to discussion, and our debaters have been given the challenge to clarify the evidence to justify their preferred option for repair of type IV-TAAAs.

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    ABSTRACT: BACKGROUND: Repair of thoracoabdominal aortic aneurysms (TAAA) represents a considerable technical challenge. Since its first description in 1955, open repair of TAAA has been considered the gold standard of repair. Despite improvements in surgical techniques, spinal cord protection and post-operative critical care support, patients who undergo open repair are faced with a mortality rate of 5-35 %. We report the first Irish experience of endovascular management of TAAAs. RESULTS: To date five patients have undergone endovascular repair; four had hybrid repair and one a fenestrated graft. The mean age of the patients was 66.8 ± 3.4 and the mean aneurysm diameter was 6.74 ± 0.6 cm. All patients were ASA III. Two-stage hybrid repair was associated with an increased risk of complications, prolonged intensive care unit and overall hospital stay. One patient died in the perioperative period due to rupture of their aneurysm between the two stages of their hybrid repair. CONCLUSION: The role of endovascular techniques in the treatment of TAAA continues to evolve. Hybrid and complete endovascular repairs do not replace conventional repair, but provide an alternative for high-risk patients who might otherwise be denied treatment.
    Irish Journal of Medical Science 06/2013; 183(2). · 0.51 Impact Factor

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