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Total endovascular repair of contained ruptured thoracoabdominal aortic aneurysms.

Annals of Vascular Surgery 2019 Februrary 12
OBJECTIVE: To report perioperative and 1-year results of total endovascular repair of contained ruptured thoracoabdominal aortic aneurysms (TAAAs).

METHODS: Between 2015 and 2017, pre-operative, procedural and post-operative data of patients with radiographic evidence of contained ruptured TAAAs treated by endovascular repair, were prospectively collected. Only patients with stable hemodynamic parameters were enclosed. Primary endpoints were: 30-day / in-hospital mortality, spinal cord ischemia (SCI), post-operative cardio-pulmonary complications and new onset of hemodialysis. Secondary endpoints were endoleaks, re-interventions and overall follow-up survival.

RESULTS: Twelve patients underwent endovascular repair for contained ruptured TAAAs. According with the Crawford/Safi's classification 6 type II (50%), 3 type III (25%), 1 type IV (8%) and 2 type V (17%) TAAAs were treated. All patients were symptomatic. Overall, 34 target visceral vessels were planned to be re-vascularized. The mean time from admission to treatment was 48 hours (range 4 - 96) with 4 patients operated within 24 hours. Five patients (42%) were treated by T-branch, 3 (25%) by custom made fenestrated/branched endografts, 3 (25%) by parallel graft technique e 1 (8%) by standard TEVAR covering a stenotic celiac trunk. The 30-day and in-hospital mortality was 17% and 25%, respectively. Two patients (17%) developed SCI. Cardiac and pulmonary complications were reported in 1 (8%) and 3 (25%) cases, respectively. One patients (8%) needed permanent hemodialysis. Two endoleaks (17%) were detected at the post-operative CTA (1 low-flow gutter endoleak and 1 type III endoleak). Four patients (33%) required re-interventions within 30 post-operative days. The mean follow-up was 12 months (range 1 - 22). No late target visceral vessels occlusion, endoleak or re-intervention occurred in this series. Overall, 7/12 (59%) patients were alive and no cases of TAAA related mortality occurred during follow-up.

CONCLUSION: According with our results, endovascular repair of contained ruptured TAAAs is feasible by a flexible approach in selected patients with anatomical suitability and stable hemodynamic conditions. Although early mortality and morbidity are significant, with frequent re-intervention necessity, subsequent follow-up is free from re-interventions and TAAA-related mortality.

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