Wholly endovascular repair of thoracoabdominal aneurysm

• Published in: British journal of surgery 2008-06, Vol.95 (6), p.703-708
• Main Authors: Gilling-Smith, G. L., McWilliams, R. G., Scurr, J. R. H., Brennan, J. A., Fisher, R. K., Harris, P. L., Vallabhaneni, S. R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia, General; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endarterectomy - methods; Female; Follow-Up Studies; General aspects; Hospital Mortality; Humans; Imaging, Three-Dimensional; Male; Medical sciences; Middle Aged; Tomography, X-Ray Computed - methods
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.6179

Background: The aim was to evaluate a wholly endovascular approach to the repair of thoracoabdominal aortic aneurysm (TAAA). Methods: Six patients (median age 71 years) underwent wholly endovascular repair of TAAA (maximum diameter 56–85 mm) employing individually customized endografts. Procedures were performed under general anaesthesia, with spinal drainage in five patients. Patients were followed by serial computed tomography, plain radiography and duplex imaging for a median of 17 (range 8–44) months. Results: All grafts were deployed as intended, with preservation of all target vessels. There were no postoperative deaths, strokes or paraplegia. One patient suffered a silent myocardial infarction. In two patients a persistent paraostial endoleak was treated by further balloon dilatation of the stent within the endograft fenestration. Imaging before discharge confirmed aneurysm exclusion in all patients. Two patients required late secondary intervention to abolish endoleaks due to side‐branch disconnection. One patient suffered late occlusion of the coeliac axis without clinical sequelae, and late occlusion of a solitary renal artery in another resulted in dependence on dialysis. There have been no late deaths and all aneurysms remain excluded. Conclusion: Wholly endovascular TAAA repair is relatively safe, but long‐term follow‐up is required to establish its durability. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. A triumph of technology