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Thoracoabdominal aortic aneurysm repair: open, endovascular, or hybrid?

  • SPECIAL EDITION
  • Controversies in Surgery for Thoracic Aorta
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Abstract

Successful repair of complex thoracoabdominal aortic aneurysms requires careful surgical planning based on anatomic and patient considerations. Not only are surgical considerations key, but also post-operative care, regardless of surgical approach, can dramatically impact both short- and long-term outcomes. While open repair has been the gold standard for decades, the technical challenges associated with operative repair, a specialty approach requisite for good outcomes, and the unique challenges in the post-operative care of these patients have given providers pause when considering operative intervention. The relatively recent development of elegant endovascular and hybrid approaches to this problem has shown improved short-term morbidity and reasonable durability. Here, we discuss these three techniques for correction of complex thoracoabdominal aortic aneurysms to provide some guidance for optimization of outcomes based on individual patient anatomy and comorbid conditions.

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References

  1. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery. 1982;92:1103–8.

    CAS  PubMed  Google Scholar 

  2. Cowan JA Jr, Dimick JB, Henke PK, Rectenwald J, Stanley JC, Upchurch GR Jr. Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. Ann N Y Acad Sci. 2006;1085:1–10.

    Article  PubMed  Google Scholar 

  3. Crawford ES, DeNatale RW. Thoracoabdominal aortic aneurysm: observations regarding the natural course of the disease. J Vasc Surg. 1986;3:578–82.

    Article  CAS  PubMed  Google Scholar 

  4. Escobar GA, Upchurch GR Jr. Management of thoracoabdominal aortic aneurysms. Curr Probl Surg. 2011;48:70–133.

    Article  PubMed  Google Scholar 

  5. Crawford ES, Crawford JL, Safi HJ, et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986;3:389–404.

    Article  CAS  PubMed  Google Scholar 

  6. Safi HJ, Miller CC 3rd. Spinal cord protection in descending thoracic and thoracoabdominal aortic repair. Ann Thorac Surg. 1999;67:1937–9 (discussion 1953–1938).

    Article  CAS  PubMed  Google Scholar 

  7. Juvonen T, Ergin MA, Galla JD, et al. Prospective study of the natural history of thoracic aortic aneurysms. Ann Thorac Surg. 1997;63:1533–45.

    Article  CAS  PubMed  Google Scholar 

  8. Kuzmik GA, Sang AX, Elefteriades JA. Natural history of thoracic aortic aneurysms. J Vasc Surg. 2012;56:565–71.

    Article  PubMed  Google Scholar 

  9. Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002;74:S1877–80 (discussion S1892–S1878).

    Article  PubMed  Google Scholar 

  10. Etheredge SN, Yee J, Smith JV, Schonberger S, Goldman MJ. Successful resection of a large aneurysm of the upper abdominal aorta and replacement with homograft. Surgery. 1955;38:1071–81.

    CAS  PubMed  Google Scholar 

  11. DeBakey ME, Crawford ES, Garrett HE, Beall AC Jr, Howell JF. Surgical considerations in the treatment of aneurysms of the thoraco-abdominal aorta. Ann Surg. 1965;162:650–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Crawford ES. Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries. Ann Surg. 1974;179:763–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Frederick JR, Woo YJ. Thoracoabdominal aortic aneurysm. Ann Cardiothorac Surg. 2012;1:277–85.

    PubMed  PubMed Central  Google Scholar 

  14. Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17:357–68 (discussion 368–370).

    Article  CAS  PubMed  Google Scholar 

  15. Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2007;83:S862–4 (discussion S890–S862).

    Article  PubMed  Google Scholar 

  16. Estrera AL, Miller CC 3rd, Chen EP, et al. Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage. Ann Thorac Surg. 2005;80:1290–6 (discussion 1296).

    Article  PubMed  Google Scholar 

  17. LeMaire SA, Price MD, Green SY, Zarda S, Coselli JS. Results of open thoracoabdominal aortic aneurysm repair. Ann Cardiothorac Surg. 2012;1:286–92.

    PubMed  PubMed Central  Google Scholar 

  18. Ferreira M, Lanziotti L, Monteiro M. Branched devices for thoracoabdominal aneurysm repair: early experience. J Vasc Surg. 2008;48:30S–6S (discussion 36S).

    Article  PubMed  Google Scholar 

  19. Iafrancesco M, Ranasinghe AM, Claridge MW, Mascaro JG, Adam DJ. Current results of endovascular repair of thoraco-abdominal aneurysms dagger. Eur J Cardiothorac Surg. 2014;46:981–4 (discussion 984).

    Article  PubMed  Google Scholar 

  20. Ferreira M, Lanziotti L, Cunha R, d’Utra G. Endovascular repair of thoracoabdominal aneurysms: results of the first 48 cases. Ann Cardiothorac Surg. 2012;1:304–10.

    PubMed  PubMed Central  Google Scholar 

  21. Reilly LM, Rapp JH, Grenon SM, Hiramoto JS, Sobel J, Chuter TA. Efficacy and durability of endovascular thoracoabdominal aortic aneurysm repair using the caudally directed cuff technique. J Vasc Surg. 2012;56:53–63 (discussion 63–54).

    Article  PubMed  Google Scholar 

  22. Tshomba Y, Melissano G, Logaldo D, et al. Clinical outcomes of hybrid repair for thoracoabdominal aortic aneurysms. Ann Cardiothorac Surg. 2012;1:293–303.

    PubMed  PubMed Central  Google Scholar 

  23. Hughes GC, Andersen ND, Hanna JM, McCann RL. Thoracoabdominal aortic aneurysm: hybrid repair outcomes. Ann Cardiothorac Surg. 2012;1:311–9.

    PubMed  PubMed Central  Google Scholar 

  24. Patel HJ, Upchurch GR Jr, Eliason JL, et al. Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair. Ann Thorac Surg. 2010;89:1475–81.

    Article  PubMed  Google Scholar 

  25. Vaaramaki S, Suominen V, Pimenoff G, Saarinen J, Uurto I, Salenius J. Hybrid repair of thoracoabdominal aortic aneurysms is a durable option for high-risk patients in the endovascular era. Vasc Endovasc Surg. 2016;50:491–6.

    Article  Google Scholar 

  26. Yamaguchi D, Jordan WD Jr. Hybrid thoracoabdominal aortic aneurysm repair: current perspectives. Semin Vasc Surg. 2012;25:203–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Joshua M. Rosenblum & Edward P. Chen

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  1. Joshua M. Rosenblum
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  2. Edward P. Chen
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Correspondence to Joshua M. Rosenblum.

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Rosenblum, J.M., Chen, E.P. Thoracoabdominal aortic aneurysm repair: open, endovascular, or hybrid?. Gen Thorac Cardiovasc Surg 67, 175–179 (2019). https://doi.org/10.1007/s11748-017-0820-y

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  • DOI: https://doi.org/10.1007/s11748-017-0820-y

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