|
|
||||||||
J Thorac Cardiovasc Surg 2007;133:1474-1482
© 2007 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
b Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.
Received for publication May 10, 2006; revisions received August 8, 2006; accepted for publication September 26, 2006. * Address for reprints: Roy Greenberg, MD, Cleveland Clinic, 9500 Euclid Avenue, Desk S40, Cleveland, OH 44195. (Email: greenbr{at}ccf.org).
Objective: To establish the safety and efficacy of endovascular repair of thoracoabdominal aortic aneurysms.
Methods: Between May 2004 and February 2006, patients with thoracoabdominal aneurysms considered high risk for conventional surgery were enrolled in a prospective trial to evaluate a novel endovascular grafting system. Devices were custom designed for each patient using high-resolution computed tomography. Patient data included mortality, morbidity, procedural details, and surrogate end points for endovascular repair. These were collected at hospital discharge and at 1, 6, and 12 months.
Results: Seventy-three patients underwent endovascular repair of thoracoabdominal aortic aneurysms for type I, II, or III (n = 28), or for type IV (n = 45) thoracoabdominal aneurysms. Mean aneurysm size was 7.1 cm (range 4.511.3 cm). General anesthesia was used in 47% of patients and regional anesthesia in 53%. There were no conversions to open surgery nor ruptures post-treatment. Technical success was achieved in 93% of patients (68/73). Thirty-day mortality was 5.5% (4/73). Major perioperative complications occurred in 11 (14%) patients and included paraplegia (2.7%, 2/73), new onset of dialysis (1.4%, 1/73), prolonged ventilator support (6.8%, 5/73), myocardial infarction (5.5%, 4/73), and minor hemorrhagic stroke (1.4%; 1/72). A majority of patients had no complications. Mean length of stay was 8.6 days. At follow-up, 6 deaths had occurred. There were no instances of stent migration nor aneurysmal growth.
Conclusions: Endovascular repair of aortic aneurysms involving the visceral segment in nonsurgical candidates is feasible. Known complications of repair are not eliminated, but morbidity and mortality appeared low relative to the high-risk population studied. Further refinement of device design, delivery technique, and patient selection is ongoing. Assessment of durability will require longer follow-up.
Related Article
J. Thorac. Cardiovasc. Surg. 2007 133: 1481-1482.
This article has been cited by other articles:
![]() |
C. J. Kwolek Are Improved Results for Hybrid Repair of Thoracoabdominal Aortic Aneurysms Due to a Learning Curve or Better Patient Selection? Circulation, December 13, 2011; 124(24): 2647 - 2648. [Full Text] [PDF] |
||||
![]() |
A. Vivacqua, T. B. Albacker, and E. E. Roselli Hybrid Thoracoabdominal Aneurysm Repair With Antegrade Visceral Debranching From the Ascending Aorta: Concomitant Cardiac Surgery and Stent-Grafting Ann. Thorac. Surg., December 1, 2011; 92(6): 2275 - 2277. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. S. Oderich, M. A. Farber, and L. A. Sanchez Urgent Endovascular Treatment of Symptomatic or Contained Ruptured Aneurysms With Modified Stent Grafts Perspectives in Vascular Surgery and Endovascular Therapy, September 1, 2011; 23(3): 186 - 194. [Abstract] [PDF] |
||||
![]() |
A. Kulik, C. F. Castner, and N. T. Kouchoukos Outcomes after thoracoabdominal aortic aneurysm repair with hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., April 1, 2011; 141(4): 953 - 960. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. W. Fehrenbacher, H. Siderys, C. Terry, J. Kuhn, and J. S. Corvera Early and late results of descending thoracic and thoracoabdominal aortic aneurysm open repair with deep hypothermia and circulatory arrest J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S154 - S160. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Greenberg, M. Eagleton, and T. Mastracci Branched endografts for thoracoabdominal aneurysms J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S171 - S178. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Zoli, F. Roder, C. D. Etz, R. M. Brenner, C. A. Bodian, H.-M. Lin, G. Di Luozzo, and R. B. Griepp Predicting the Risk of Paraplegia After Thoracic and Thoracoabdominal Aneurysm Repair Ann. Thorac. Surg., October 1, 2010; 90(4): 1237 - 1245. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. E. Roselli, E. G. Soltesz, T. Mastracci, L. G. Svensson, and B. W. Lytle Antegrade Delivery of Stent Grafts to Treat Complex Thoracic Aortic Disease Ann. Thorac. Surg., August 1, 2010; 90(2): 539 - 546. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. Matsuda, H. Ogino, T. Fukuda, O. Iritani, S. Sato, Y. Iba, H. Tanaka, H. Sasaki, K. Minatoya, J. Kobayashi, et al. Multidisciplinary Approach to Prevent Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair for Distal Descending Aorta Ann. Thorac. Surg., August 1, 2010; 90(2): 561 - 565. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. D. Etz, S. Zoli, C. S. Mueller, C. A. Bodian, G. Di Luozzo, R. Lazala, K. A. Plestis, and R. B. Griepp Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. J. Thorac. Cardiovasc. Surg., June 1, 2010; 139(6): 1464 - 1472. [Abstract] [Full Text] [PDF] |
||||
![]() |
American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society of Interventional Radiology, Society of Thoracic Surgeons, Society for Vascular Medicine, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease J. Am. Coll. Cardiol., April 6, 2010; 55(14): e27 - e129. [Full Text] [PDF] |
||||
![]() |
WRITING GROUP MEMBERS, L. F. Hiratzka, G. L. Bakris, J. A. Beckman, R. M. Bersin, V. F. Carr, D. E. Casey Jr, K. A. Eagle, L. K. Hermann, E. M. Isselbacher, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine Circulation, April 6, 2010; 121(13): e266 - e369. [Full Text] [PDF] |
||||
![]() |
T. Shimamoto, A. Marui, Y. Nagata, M. Sato, N. Saito, T. Takeda, M. Ueda, T. Ikeda, R. Sakata, and K. Inoue A novel approach to prevent spinal cord ischemia: Inoue stent graft with a side branch of small caliber for the reconstruction of the artery of Adamkiewicz J. Thorac. Cardiovasc. Surg., March 1, 2010; 139(3): 655 - 659. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. S. Oderich and J. J. Ricotta Modified Fenestrated Stent Grafts: Device Design, Modifications, Implantation, and Current Applications Perspectives in Vascular Surgery and Endovascular Therapy, September 1, 2009; 21(3): 157 - 167. [Abstract] [PDF] |
||||
![]() |
V. Kurra, P. Schoenhagen, E. E. Roselli, S. R. Kapadia, E. M. Tuzcu, R. Greenberg, M. Akhtar, M. Y. Desai, S. D. Flamm, S. S. Halliburton, et al. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: Preprocedural assessment with multidetector computed tomography. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1258 - 1264. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. P. Siegenthaler, E. Weigang, K. Brehm, W. Euringer, T. Baumann, M. Uhl, S. Raghu, and F. Beyersdorf Endovascular treatment for thoracoabdominal aneurysms: outcomes and results Eur J Cardiothorac Surg, October 1, 2008; 34(4): 810 - 819. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. K. Greenberg, Q. Lu, E. E. Roselli, L. G. Svensson, M. C. Moon, A. V. Hernandez, J. Dowdall, M. Cury, C. Francis, K. Pfaff, et al. Contemporary Analysis of Descending Thoracic and Thoracoabdominal Aneurysm Repair: A Comparison of Endovascular and Open Techniques Circulation, August 19, 2008; 118(8): 808 - 817. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. J. Ricotta and G. S. Oderich Fenestrated and Branched Stent Grafts Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2008; 20(2): 174 - 187. [Abstract] [PDF] |
||||
![]() |
R. K. Greenberg and B. Lytle Endovascular Repair of Thoracoabdominal Aneurysms Circulation, April 29, 2008; 117(17): 2288 - 2296. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Senay, C. Alhan, H. Karabulut, F. Toraman, and H. Cagil Endovascular Treatment of Rapidly Expanding Thoracoabdominal Aortic Aneurysm After Surgical Repair of Acute Type A Dissection Ann. Thorac. Surg., February 1, 2008; 85(2): 636 - 638. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. D. Etz, M. Luehr, F. A. Kari, C. A. Bodian, D. Smego, K. A. Plestis, and R. B. Griepp Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: does critical spinal cord ischemia occur postoperatively? J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 324 - 330. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. Schoenhagen Back to the future: coronary CT angiography using prospective ECG triggering Eur. Heart J., January 2, 2008; 29(2): 153 - 154. [Full Text] [PDF] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |