Visceral transposition followed by endovascular prosthesis for treatment of thoracoabdominal aortic aneurysms: a hybrid approach

P. Roth; A. Breithecker; J. Babin-Ebell; G. Goerlach; C. Orhan; W. Rau; A. Böning

doi:10.1055/s-2008-1037851

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Visceral transposition followed by endovascular prosthesis for treatment of thoracoabdominal aortic aneurysms: a hybrid approach

P Roth ¹, A Breithecker ², J Babin-Ebell ¹, G Goerlach ¹, C Orhan ¹, W Rau ², A Böning ¹

¹University Hospital Gießen and Marburg, Campus Gießen, Dept. of Cardiac-, Paediatric Cardiac- and Vascular Surgery, Gießen, Germany
²University Hospital Gießen and Marburg, Campus Gießen, Dept. of Diagnostik Radiology, Gießen, Germany

Abstract

Objective: Open surgical treatment of thoracoabdominal aortic aneurysms (TAAA) entails a relatively high mortality and paraplegia risk, which can possibly be attenuated by endovascular aortic repair (EVAR).

Patients and methods: From Sept. 2003 to July 2007, 14 patients were admitted for treatment of TAAA. 6 patients of this group (mean age 54,2 years, 2 male, 4 female) underwent visceral transposition (VTr), followed by scheduled EVAR. VTr was carried out using a reversed y-prosthesis with side branches to the renal arteries grafting the superior mesenteric artery and the mesenteric trunk. All grafted arteries were ligated proximally. In a second intervention, a custom-made stent graft was applied to cover aneurysmatic aortic areas.

Results: The hybrid procedure was successfully completed in 5 patients. One patient is still waiting for EVAR after VTr was done. There was no mortality (30 day), paraplegia or stroke and one renal failure observed among the 6 patients. Follow up period was 2 to 28 months (mean 13,2). One patient died after 24 months for unknown reasons. However, several complications had to be treated. There was no patient without complications because every patient required one additional complication related intervention. The mean number of procedures/patient was 4 (range 2–8). 27 vascular prostheses (mean 4,5/patient) and 15 endovascular stents (mean 3/patient) were implanted.

Conclusion: Despite low early mortality and paraplegia rate, a hybrid procedure consisting of VTr and EVAR for treatment of TAAA cannot yet be regarded as more superior than surgical repair due to high postoperative complication rate.