Results of Open Thoracoabdominal Aortic Replacement in Patients Unsuitable for and after Failed Endovascular Aortic Repair

Objectives: To evaluate outcome in all-comer patients undergoing open thoracoabdominal aortic replacement either unsuitable for or after failed endovascular aortic repair.

Methods: Within a 4-year period, we analyzed a consecutive series of patients undergoing elective, urgent and emergent thoracoabdominal aortic replacement. Preoperative data, intraoperative data and outcome were evaluated. Specific attention was given to technical refinements needed in patients after previous endovascular aortic repair.

Result: Eighty patients underwent thoracoabdominal aortic replacement, n = 9 (11.3%) had connective tissue disorders. Twenty-six patients (32.5%) were unsuitable for or after failed endovascular aortic repair. Mean age was 64.2 ±12 and 70% (n = 56) were male. Mean EuroSCORE was 7.9 ±2.6. Urgent or emergent operations were done in n = 18 (22.5%). Overall mortality was 20% (n = 16) and symptomatic spinal cord injury occurred in n = 3 (3.8%). We did neither observe differences in survival according to age (<65, p = 0.884) nor to the presence or absence of previous endovascular repair prior to open surgery (p = 0.524). During follow-up aortic related mortality was 9.0% (n = 7) and freedom from aortic-related reintervention was 96.3%.

Conclusion: Despite a substantial perioperative mortality, aortic-related survival is excellent and freedom from aortic-related reintervention is high. Open surgery continues to remain an essential component in the treatment armamentarium of acute and chronic thoracoabdominal aortic pathology.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021