Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE
Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Tsuyoshi Shibata, Shuhei Miura, Nobuyoshi Kawaharada
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Abstract

Objective

Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated.

Methods

This was a retrospective and observational study. From January 2010 to June 2022, 20 patients who underwent open aortic repair after TEVAR were included. The indications for open conversion surgery were as follows: aortic enlargement due to endoleak (EL) in seven patients (type Ia: n = 4, type II: n = 1, type V: n = 2; 35%), stent graft infection including aorto-oesophageal fistula (AEF) in six (30%), retrograde type A aortic dissection (RTAD) in three (15%), and dilatation of adjacent distal aorta or false lumen in four (20%).

Results

Seven patients with type Ia EL or RTAD required open aortic arch repair. Four underwent thoraco-abdominal aortic repair for distal aortic enlargement. Descending thoracic aortic replacement was performed in all six infection cases and two patients with type V EL. Furthermore, three patients with AEF received concomitant oesophagectomy. One patient with persistent type II EL underwent intercostal artery ligation and aneurysmorrhaphy via thoracotomy. There were two in hospital deaths (10%), all with AEF. Thus, the rates of in hospital death were 0% in non-infected cases, 33% in graft infections, with 66% in those with AEF. Stroke and paraplegia were observed in two patients (10%).

Conclusion

When open conversion surgery is required after TEVAR, the indications are complex, often associated with infectious pathology, and are necessarily high risk particularly in patients with AEF. Surgical strategy has to be individualised based on the nature or cause of the complication and extent of aortic involvement.
胸腔血管内主动脉修复后的开放主动脉修复:从单中心手术经验的战略见解
目的胸主动脉血管内修复术(TEVAR)在胸主动脉手术中应用广泛。然而,由于各种原因,一些患者需要二次主动脉切开修复。本文就TEVAR后开放性转换手术的手术效果及存在的问题进行探讨。方法回顾性观察性研究。从2010年1月到2022年6月,纳入了20例在TEVAR后接受开放主动脉修复的患者。开放转换手术的适应症如下:7例患者因内漏(EL)导致主动脉扩张(Ia型:n = 4例,II型:n = 1例,V型:n = 2例;35%),支架感染包括主动脉-食管瘘(AEF) 6例(30%),逆行A型主动脉夹层(RTAD) 3例(15%),邻近远端主动脉扩张或假腔4例(20%)。结果7例Ia型EL或RTAD患者需开腹主动脉弓修复。4例因主动脉远端扩大而行胸腹主动脉修补术。6例感染患者和2例V型EL患者均行降主动脉置换术。此外,3例AEF患者同时接受了食管切除术。1例持续性II型EL患者通过开胸行肋间动脉结扎和动脉瘤吻合术。住院死亡2例(10%),均为急性心衰。因此,非感染病例的住院死亡率为0%,移植物感染为33%,AEF患者为66%。脑卒中和截瘫2例(10%)。结论TEVAR术后需要开腹转换手术时,适应症复杂,常与感染性病理相关,且必然存在高风险,尤其是AEF患者。手术策略必须根据并发症的性质或原因以及主动脉受累程度进行个体化治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
EJVES Vascular Forum
EJVES Vascular Forum Medicine-Surgery
CiteScore
1.50
自引率
0.00%
发文量
145
审稿时长
102 days
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