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Current results of endovascular repair of thoraco-abdominal aneurysms†.

Iafrancesco, Mauro and Ranasinghe, Aaron M and Claridge, Martin W and Mascaro, Jorge G and Adam, Donald J (2014) Current results of endovascular repair of thoraco-abdominal aneurysms†. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 46 (6). 981-4; discussion 984. ISSN 1873-734X. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://ejcts.oxfordjournals.org/content/46/6/981.f...

Abstract

OBJECTIVES

Fenestrated and branch endografts represent a totally endovascular solution for high-risk patients with atherosclerotic thoraco-abdominal aortic aneurysms (TAAAs). This study reports the early outcome of endovascular TAAA repair.

METHODS

Interrogation of a prospective database of consecutive patients who underwent endovascular repair (EVAR) for TAAA between June 2007 and October 2012.

RESULTS

Sixty-two high-risk patients (55 men; median age 72, range 54-84 years) underwent fenestrated (n = 39) or branch (n = 23) EVAR for non-ruptured TAAA [extent I-III (n = 26) and IV (n = 36)]. Twenty patients had undergone 22 previous aortic procedures. A total of 221 target vessels (coeliac 50, superior mesenteric 61, renal 106, left subclavian 1 and hypogastric 3) were preserved with scallops (n = 17), fenestrations (n = 140) or branches (n = 62) and 201 of these vessels were stent-grafted (coeliac 34, superior mesenteric 58, renal 105, left subclavian 1 and hypogastric 3). The 30-day mortality was 1.6% (n = 1) and one further patient died on postoperative day 62 from respiratory complications. Spinal cord injury (SCI) developed in 5 (8%) patients (3 women and 2 men). Two patients required temporary renal replacement therapy and a further two commenced planned postoperative dialysis.

CONCLUSIONS

In high-risk patients with TAAA, fenestrated and branch EVAR is associated with low early mortality and requirement for renal support, but the risk of SCI is not insignificant despite the use of cerebrospinal fluid drainage and blood pressure manipulation. Our current practice is to stage the repair of extent I-III aneurysms and this has significantly reduced the incidence of SCI.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
Divisions: Planned IP Care > Vascular
Planned IP Care > Thoracic Surgery
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Depositing User: Mrs Caroline Tranter
Date Deposited: 31 May 2015 08:08
Last Modified: 31 May 2015 08:08
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/958

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