Long-term results of second-stage thoracic endovascular aortic repair following total aortic arch replacement

• Published in: General thoracic and cardiovascular surgery Vol. 58; no. 10; pp. 501 - 505
• Main Authors: Obitsu, Yukio, Koizumi, Nobusato, Iida, Yasunori, Iwahashi, Toru, Saiki, Naozumi, Watanabe, Yoshiko, Takae, Hisahito, Kawaguchi, Satoshi, Shigematsu, Hiroshi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.10.2010; Springer Nature B.V
• Subjects: Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aneurysms; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Cardiac Surgery; Cardiology; Cardiovascular surgical procedure; Dissecting aneurysms; Dissection; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Humans; Japan; Medicine; Medicine & Public Health; Original Article; Prosthesis Design; Retrospective Studies; Surgical Oncology; Thoracic aneurysms; Thoracic endovascular aortic repair; Thoracic Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Thoracic aneurysms; Thoracic endovascular aortic repair; Dissecting aneurysms; Cardiovascular surgical procedure
• ISSN: 1863-6705; 1863-6713; 1863-6713
• DOI: 10.1007/s11748-010-0627-6

Purpose We investigated the surgical results of secondary thoracic endovascular aneurysm repair (TEVAR) using the elephant trunk graft after total aortic arch replacement (TAR) for extensive thoracic aortic lesions. Methods The subjects comprised 16 patients who underwent TEVAR as a staged procedure following TAR at our institution between 1997 and 2007. Long-term results were retrospectively surveyed (mean observation period 68.4 months). We performed TEVAR with the elephant trunk graft as a proximal landing zone for the descending thoracic repair, the mean duration between TAR and TEVAR was 4.7 weeks for the staged operations and 18.3 months for the nonstaged operations. Results Early results were good in all cases, with no deaths and no noteworthy complications. For the seven patients without dissection, long-term results were also good. Among the nine patients with dissection, the false lumen in the thoracoabdominal area enlarged in three during follow-up. We performed thoracoabdominal repair in two, but one died of an aneurysm-esophageal fistula. There was only one long-term aneurysm-related death. Conclusion Second-stage TEVAR using the elephant trunk graft after TAR allows less invasive surgery for extensive aortic lesions and achieves good long-term results. However, enlargement of the false lumen was a long-term concern in patients with aortic dissection, and careful follow-up is essential.