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Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm.

Publication ,  Journal Article
Hughes, GC; Barfield, ME; Shah, AA; Williams, JB; Kuchibhatla, M; Hanna, JM; Andersen, ND; McCann, RL
Published in: J Vasc Surg
September 2012

OBJECTIVE: Thoracoabdominal aortic aneurysms (TAAAs) occur most commonly in elderly individuals, who are often suboptimal candidates for open repair because of significant comorbidities. The availability of a hybrid option, including open visceral debranching with endovascular aneurysm exclusion, may have advantages in these patients who are at high-risk for conventional repair. This report details the evolution of our technique and results with complete visceral debranching and endovascular aneurysm exclusion for TAAA repair in high-risk patients. METHODS: Between March 2005 and June 2011, 47 patients (51% women) underwent extra-anatomic debranching of all visceral vessels, followed by aneurysm exclusion by endovascular means at a single institution. A median of four visceral vessels were bypassed. The debranching procedure was initially performed through a partial right medial visceral rotation approach, leaving the left kidney posterior in the first 22 patients, and in the last 25 by a direct anterior approach to the visceral vessels. The debranching and endovascular portions of the procedure were performed in a single operation in the initial 33 patients and as a staged procedure during a single hospital stay in the most recent 14. RESULTS: Median patient age was 71.0 ± 9.8 years. All had significant comorbidity and were considered suboptimal candidates for conventional repair: 55% had undergone previous aortic surgery, 40% were American Society of Anesthesiologists (ASA) class 4, and baseline serum creatinine was 1.5 ± 1.3 mg/dL. The 30-day/in-hospital rates of death, stroke, and permanent paraparesis/plegia were 8.5%, 0%, and 4.3%, respectively, but 0% in the most recent 14 patients undergoing staged repair. These patients had significantly shorter combined operative times (314 vs 373 minutes), decreased intraoperative red blood cell transfusions (350 vs 1400 mL), and were more likely to be extubated in the operating room (50% vs 12%) compared with patients undergoing simultaneous repair. Over a median follow-up of 19.3 ± 18.5 months, visceral graft patency was 97%; all occluded limbs were to renal vessels and clinically silent. There have been no type I or III endoleaks or reinterventions. Kaplan-Meier overall survival is 70.7% at 2 years and 57.9% at 5 years. CONCLUSIONS: Hybrid TAAA repair through complete visceral debranching and endovascular aneurysm exclusion is a good option for elderly high-risk patients less suited to conventional repair in centers with the requisite surgical expertise with visceral revascularization. A staged approach to debranching and endovascular aneurysm exclusion during a single hospitalization appears to yield optimal results.

Duke Scholars

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

September 2012

Volume

56

Issue

3

Start / End Page

621 / 629

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Postoperative Complications
  • Odds Ratio
  • North Carolina
 

Citation

APA
Chicago
ICMJE
MLA
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Hughes, G. C., Barfield, M. E., Shah, A. A., Williams, J. B., Kuchibhatla, M., Hanna, J. M., … McCann, R. L. (2012). Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm. J Vasc Surg, 56(3), 621–629. https://doi.org/10.1016/j.jvs.2011.11.149
Hughes, G Chad, Michael E. Barfield, Asad A. Shah, Judson B. Williams, Maragatha Kuchibhatla, Jennifer M. Hanna, Nicholas D. Andersen, and Richard L. McCann. “Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm.J Vasc Surg 56, no. 3 (September 2012): 621–29. https://doi.org/10.1016/j.jvs.2011.11.149.
Hughes GC, Barfield ME, Shah AA, Williams JB, Kuchibhatla M, Hanna JM, et al. Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm. J Vasc Surg. 2012 Sep;56(3):621–9.
Hughes, G. Chad, et al. “Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm.J Vasc Surg, vol. 56, no. 3, Sept. 2012, pp. 621–29. Pubmed, doi:10.1016/j.jvs.2011.11.149.
Hughes GC, Barfield ME, Shah AA, Williams JB, Kuchibhatla M, Hanna JM, Andersen ND, McCann RL. Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm. J Vasc Surg. 2012 Sep;56(3):621–629.
Journal cover image

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

September 2012

Volume

56

Issue

3

Start / End Page

621 / 629

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Postoperative Complications
  • Odds Ratio
  • North Carolina