Mid-Term Outcomes of Complex Endografting for Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms
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CLINICAL INVESTIGATION
ARTERIAL INTERVENTIONS
Mid-Term Outcomes of Complex Endografting for Chronic PostDissection Thoracoabdominal Aortic Aneurysms Fabio Verzini1 • Ciro Ferrer2 • Gianbattista Parlani3 • Carlo Coscarella2 • Rocco Giudice2 • Edoardo Frola1 • Maria Antonella Ruffino4 • Gianfranco Varetto1 Lorenzo Gibello1
•
Received: 24 March 2020 / Accepted: 4 June 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To report early and mid-term results of postaortic dissection thoracoabdominal aneurysms (pD-TAAA) treated by complex endografting in three tertiary referral hospitals. Materials and methods A review of all patients with pDTAAA unfit for open surgery treated with complex endovascular repair from 2012 to 2018 was performed. Simple thoracic endografts (TEVAR) were excluded. Staged procedures in case of extensive aortic coverage were always planned. Results In total, 21 patients (16 males, mean age 63 ± 10 years) with pD-TAAA underwent aortic repair by fenestrated or branched thoracoabdominal endografts for visceral vessels. Mean TAAA diameter was 61 ± 6.2 mm. Spinal cord drainage was performed in all patients. A staged approach was used in 12 (57%) cases. Technical success was achieved in 18 (86%) patients. No in-hospital deaths occurred. Two patients experienced transient postprocedural spinal cord ischemia. At 30 days, six type II endoleaks (29%), two type Ic endoleak (9.5%) and one & Fabio Verzini [email protected] 1
Unit of Vascular Surgery, Department of Surgical Sciences, AOU Citta` della Salute e della Scienza, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
2
Vascular and Endovascular Surgery Unit, S GiovanniAddolorata Hospital, Rome, Italy
3
Vascular and Endovascular Surgery Unit, A.O. Perugia, Perugia, Italy
4
Vascular Radiology, Department of Diagnostic Imaging and Radiotherapy, AOU Citta` della Salute e della Scienza, Turin, Italy
type IIIc endoleak (5%) were reported. At a mean followup of 23 ± 13 months, no late aortic-related deaths occurred. Three patients underwent reintervention for type Ic and IIIc endoleaks. No visceral vessel occlusion was observed. Estimated freedom from reintervention at 12 and 24 months was 85.7 ± 0.7%. In 13 cases, TAAA diameter decreased at least 5 mm, while increased [ 5 mm in only one case. Complete false lumen thrombosis was achieved in 18 patients (86%). Conclusion Complex endografting for pD-TAAA showed favorable mid-term results. Staged and carefully planned endovascular procedures may represent a safe and effective therapeutic option in patients deemed at high risk of open repair. Keywords Chronic dissection Thoracoabdominal Aortic aneurysm TEVAR Complex endografting Fenestrated Aortic dissection
Introduction Uncomplicated type B aortic dissection (TBAD) at the time of diagnosis requires strict blood pressure control and radiological monitoring [1, 2]. Different studies, however, reported a 30-da
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