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Open aortic surgery after thoracic endovascular aortic repair

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Abstract

In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

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Fig. 1

Reproduced with permission from LeMaire et al. [13], Fig. 2. Copyright: The Society of Thoracic Surgeons

Fig. 2

Reproduced with permission from LeMaire et al. [13], Fig. 1. Copyright: The Society of Thoracic Surgeons

Fig. 3

Reproduced with permission from LeMaire et al. [13], Fig. 3. Copyright: The Society of Thoracic Surgeons

Fig. 4

Printed with the permission of Baylor College of Medicine

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA

    Joseph S. Coselli, Konstantinos Spiliotopoulos, Ourania Preventza, Kim I. de la Cruz, Hiruni Amarasekara & Susan Y. Green

  2. Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA

    Joseph S. Coselli, Konstantinos Spiliotopoulos, Ourania Preventza, Kim I. de la Cruz, Hiruni Amarasekara & Susan Y. Green

  3. CHI St. Luke’s Health-Baylor St. Luke’s Medical Center, Houston, TX, USA

    Joseph S. Coselli, Konstantinos Spiliotopoulos, Ourania Preventza & Kim I. de la Cruz

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  1. Joseph S. Coselli
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  2. Konstantinos Spiliotopoulos
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Correspondence to Joseph S. Coselli.

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Coselli, J.S., Spiliotopoulos, K., Preventza, O. et al. Open aortic surgery after thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 64, 441–449 (2016). https://doi.org/10.1007/s11748-016-0658-8

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