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Current status of endovascular treatment for thoracoabdominal aortic aneurysms

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Abstract

Open surgical repair (OSR) for thoracoabdominal aortic aneurysms (TAAAs) is maximally invasive and associated with high rates of operative mortality and perioperative complications including spinal cord ischemia (SCI), despite improvements in surgical techniques and perioperative care. Elderly patients, patients with a history of aortic surgery, and patients with severe comorbidities are often considered ineligible for this surgery and endovascular treatment may be their only treatment option. Total endovascular aneurysm repair (t-EVAR) without debranching surgery does not require thoracotomy and laparotomy and could improve the outcomes of these patients. t-EVAR includes fenestrated EVAR (f-EVAR), multi-branched EVAR (b-EVAR), and physician-modified fenestration endograft (PMFG). Although these techniques have achieved lower mortality rates than OSR, there are concerns about perioperative complications including limb ischemia, SCI, and long-term outcomes such as endograft migration and endoleaks (ELs). This article provides an overview of available endovascular devices for TAAAs and reviews the short and mid-term results of t-EVAR, as well as alternative options.

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  1. Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Takeshi Baba, Takao Ohki & Koji Maeda

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  1. Takeshi Baba
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  2. Takao Ohki
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Correspondence to Takeshi Baba.

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Takao Ohki is a paid consultant for WL Gore & Associates. The other authors have no conflicts of interest to disclose.

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Baba, T., Ohki, T. & Maeda, K. Current status of endovascular treatment for thoracoabdominal aortic aneurysms. Surg Today 50, 1343–1352 (2020). https://doi.org/10.1007/s00595-019-01917-3

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