Open Repair of Aneurysms of the Thoracoabdominal Aorta

Abstract

Background Open surgical repair of aneurysms in the descending and thoracoabdominal aorta remains the dominating treatment of choice at many institutions worldwide. Patients treated with open repair most probably differ from endovascularly treated patients. With the present distribution of procedures performed for thoracoabdominal aortic aneurysms (TAAA), one cannot foresee any randomized controlled trial within the field. Several reports have, however, described similar midterm survival after open and endovascular repair. The objective of this report is to contribute the results from a contemporary series of open repair for TAAA at a dedicated aortic center.

Methods All patients treated with open surgery for TAAA in the Stockholm County from 2007 to 2012 were included in the analysis. They were identified in the hospital administrative chart systems for operations and care.

Results Twenty-eight patients were treated for TAAA, with a mean age of 61 (30–85) years, and 75% were male. Mean operative time was 573 (±190 minutes); left heart bypass was used in 75% of the operations and cardiopulmonary bypass in 25%. All patients had two to five visceral arteries reimplanted. During a 1-year follow-up period, one patient (3.6%) suffered permanent hemodialysis, one (3.6%) had a stroke, three (10.7%) had bowel ischemia, four (14.3%) had postoperative symptoms of spinal ischemia, and two of them (7.1%) had permanent paraplegia. No one died within 30 days, three patients (10.7%) died within 3 months, and 1-year mortality was 10.7%.

Conclusion In an era of evolving endovascular alternatives to open surgery for TAAA, this contemporary series from an aortic center show excellent results that are comparable to most series of treated TAAA, both open and endovascular. It is highly probable that the case selection for the two treatment options should be made in centralized dedicated aortic centers with skills to handle all strategies of care.

Keywords

thoracoabdominal aortic aneurysms - mortality - open repair - spinal cord ischemia

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