Objectives: We demonstrate our experience and the outcome of using a perfusion branch for temporary
sac perfusion to reduce the spinal cord ischemia (SCI) in the endovascular repair
of thoracoabdominal aortic aneurysms (TAAAs).
Methods: Between January 2012 and August 2016, thirty patients (18, men; median age 72 years)
were treated for TAAAs with total endovascular repair using customized branched /
fenestrated endografts in our institution. The median aneurysm size was 6.6 cm. Types
of TAAA were: type I, 9 (30%), type II, 5 (16.6%), type III, 4 (13.3%), type IV, 6
(20%), and type V, 6 (20%). Ten patients received a perfusion branch to create an
intentional endoleak, which was occluded with vascular plugs in mean interval time
of 8.2 weeks (range: 6–10). At the time of the planned re-interventions, the mean
arterial pressure (MAP) gradients were measured between the temporarily perfused aneurysm
sac and the aortic endografts and were significantly higher (mean gradients 42.5 ± 10
mm Hg; range: 30–60) within the aortic grafts. Staged procedure and automated Cerebrospinal
fluid drainage were used in 23 (77%) and 24 (80%) patients respectively.
Results: The technical success was 97%. A total of 107 renovisceral target vessels were revascularized
(32 fenestrations, 75 branches). The in-hospital and 30 days mortality was 3.3%. The
overall incidence of postoperative SCI was 10% (3/30 patients) and no neurologic complications
were observed in the group of the perfusion branch. The mean follow up was 12 months
(range: 2–51).
Conclusion: In our experience, the use of dedicated perfusion branch is feasible and may serve
as protective adjuvant to reduce the risk of SCI in endovascular treatment of TAAA.
The risk of rupture in interval appears to be low. Larger series and multicenter studies
are of course warranted to corroborate these results.
