Endovascular Repair of Thoracic Aortic Aneurysms

ABSTRACT

Degenerative aneurysms of the thoracic aorta are increasing in prevalence; open repair of descending thoracic aortic aneurysms is associated with high rates of morbidity and mortality. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution, the elements of which are discussed here.

KEYWORDS

Thoracic endovascular aneurysm repair (TEVAR) - aneurysm - endograft - stent graft - aorta

REFERENCES

• 1 Bickerstaff L K, Pairolero P C, Hollier L H et al.. Thoracic aortic aneurysms: a population-based study.  Surgery. 1982;  92 (6) 1103-1108
• 2 Clouse W D, Hallett Jr J W, Schaff H V, Gayari M M, Ilstrup D M, Melton III L J. Improved prognosis of thoracic aortic aneurysms: a population-based study.  JAMA. 1998;  280 (22) 1926-1929
• 3 Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002.  Circulation. 2006;  114 (24) 2611-2618
• 4 Davies R R, Goldstein L J, Coady M A et al.. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size.  Ann Thorac Surg. 2002;  73 (1) 17-27 discussion 27-28
• 5 Albornoz G, Coady M A, Roberts M et al.. Familial thoracic aortic aneurysms and dissections—incidence, modes of inheritance, and phenotypic patterns.  Ann Thorac Surg. 2006;  82 (4) 1400-1405
• 6 Coady M A, Rizzo J A, Hammond G L et al.. Surgical intervention criteria for thoracic aortic aneurysms: a study of growth rates and complications.  Ann Thorac Surg. 1999;  67 (6) 1922-1926 discussion 1953-1958
• 7 Johansson G, Markström U, Swedenborg J. Ruptured thoracic aortic aneurysms: a study of incidence and mortality rates.  J Vasc Surg. 1995;  21 (6) 985-988
• 8 Lobato A C, Puech-Leão P. Predictive factors for rupture of thoracoabdominal aortic aneurysm.  J Vasc Surg. 1998;  27 (3) 446-453
• 9 Griepp R B, Ergin M A, Galla J D et al.. Natural history of descending thoracic and thoracoabdominal aneurysms.  Ann Thorac Surg. 1999;  67 (6) 1927-1930 discussion 1953-1958
• 10 De Bakey M E, Cooley D A. Successful resection of aneurysm of thoracic aorta and replacement by graft.  J Am Med Assoc. 1953;  152 (8) 673-676
• 11 Conrad M F, Ergul E A, Patel V I, Paruchuri V, Kwolek C J, Cambria R P. Management of diseases of the descending thoracic aorta in the endovascular era: a Medicare population study.  Ann Surg. 2010;  252 (4) 603-610
• 12 Schermerhorn M L, Giles K A, Hamdan A D, Dalhberg S E, Hagberg R, Pomposelli F. Population-based outcomes of open descending thoracic aortic aneurysm repair.  J Vasc Surg. 2008;  48 (4) 821-827
• 13 Achneck H E, Rizzo J A, Tranquilli M, Elefteriades J A. Safety of thoracic aortic surgery in the present era.  Ann Thorac Surg. 2007;  84 (4) 1180-1185 discussion 1185
• 14 Dake M D, Miller D C, Semba C P, Mitchell R S, Walker P J, Liddell R P. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms.  N Engl J Med. 1994;  331 (26) 1729-1734
• 15 Gopaldas R R, Huh J, Dao T K et al.. Superior nationwide outcomes of endovascular versus open repair for isolated descending thoracic aortic aneurysm in 11,669 patients.  J Thorac Cardiovasc Surg. 2010;  140 (5) 1001-1010
• 16 Greenberg R K, Lu Q, Roselli E E et al.. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques.  Circulation. 2008;  118 (8) 808-817
• 17 Elefteriades J A. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks.  Ann Thorac Surg. 2002;  74 (5) S1877-1880 discussion S1892-1898
• 18 Davies R R, Gallo A, Coady M A et al.. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms.  Ann Thorac Surg. 2006;  81 (1) 169-177
• 19 Lee W A. Failure modes of thoracic endografts: Prevention and management.  J Vasc Surg. 2009;  49 (3) 792-799
• 20 Chiesa R, Melissano G, Marrocco-Trischitta M M, Civilini E, Setacci F. Spinal cord ischemia after elective stent-graft repair of the thoracic aorta.  J Vasc Surg. 2005;  42 (1) 11-17
• 21 Feezor R J, Martin T D, Hess P J et al.. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR).  J Endovasc Ther. 2007;  14 (4) 568-573
• 22 Appoo J J, Moser W G, Fairman R M et al.. Thoracic aortic stent grafting: improving results with newer generation investigational devices.  J Thorac Cardiovasc Surg. 2006;  131 (5) 1087-1094
• 23 Rizvi A Z, Murad M H, Fairman R M, Erwin P J, Montori V M. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis.  J Vasc Surg. 2009;  50 (5) 1159-1169
• 24 Matsumura J S, Lee W A, Mitchell R S Society for Vascular Surgery et al. The Society for Vascular Surgery Practice Guidelines: management of the left subclavian artery with thoracic endovascular aortic repair.  J Vasc Surg. 2009;  50 (5) 1155-1158
• 25 Conrad M F, Ye J Y, Chung T K, Davison J K, Cambria R P. Spinal cord complications after thoracic aortic surgery: long-term survival and functional status varies with deficit severity.  J Vasc Surg. 2008;  48 (1) 47-53
• 26 Safi H J, Estrera A L, Miller C C et al.. Evolution of risk for neurologic deficit after descending and thoracoabdominal aortic repair.  Ann Thorac Surg. 2005;  80 (6) 2173-2179 discussion 2179
• 27 Crawford E S, Crawford J L, Safi H J 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 (3) 389-404
• 28 Estrera A L, Miller III C C, Huynh T T, Porat E, Safi H J. Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair.  Ann Thorac Surg. 2001;  72 (4) 1225-1230 discussion 1230-1231
• 29 Zoli S, Roder F, Etz C D et al.. Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair.  Ann Thorac Surg. 2010;  90 (4) 1237-1244 discussion 1245
• 30 Cambria R P, Davison J K, Carter C et al.. Epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair: A five-year experience.  J Vasc Surg. 2000;  31 (6) 1093-1102
• 31 Griepp R B, Griepp E B. Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept. Ann Thorac Surg.  2007;  83 (2) S865-S869 discussion S890-S892
• 32 Cinà C S, Abouzahr L, Arena G O, Laganà A, Devereaux P J, Farrokhyar F. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: a systematic review and meta-analysis.  J Vasc Surg. 2004;  40 (1) 36-44
• 33 Cheung A T, Pochettino A, McGarvey M L et al.. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms.  Ann Thorac Surg. 2005;  80 (4) 1280-1288 discussion 1288-1289
• 34 Leurs L J, Bell R, Degrieck Y, Thomas S, Hobo R, Lundbom J. EUROSTAR . Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.  J Vasc Surg. 2004;  40 (4) 670-679 discussion 679-680