Open Surgery of the Descending Thoracic Aorta in the Endovascular Era: A Single Centre Experience

IF 8.5 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2026-10-01 Epub Date: 2025-12-12 DOI:10.1016/j.ejvs.2025.12.020

Nesar A. Hasami, Michelle Smulders, Michel W.A. Verkroost, Wilson W.L. Li, Foeke J.H. Nauta, Nabil Saouti, Guillaume S.C. Geuzebroek, Robin H. Heijmen

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The ninety day mortality rate was 6% (<em>n</em> = 5). Major complications included stroke (<em>n</em> = 1; 1%) and spinal cord ischaemia (<em>n</em> = 2; 2%; one transient paraparesis and one permanent paraplegia). No cases required tracheostomy or permanent dialysis. In hospital re-intervention was observed in 15% and acute kidney injury in 12% (including one patient requiring temporary dialysis). Mean follow up ± standard deviation was 49.0 ± 38.5 months. One and five year overall survival were 94.7% and 91.6%, respectively, and freedom from aortic related re-intervention was 96.8% and 94.7%, respectively.</div></div><div>Among 337 patients who underwent open thoraco-(abdominal) aortic repair, 95 (55 men; 58%), with a mean age ± standard deviation of 56.1 ± 14.0 years, underwent isolated DTA repair (71 elective; 75%). The most common indication was post-dissection aneurysm (<em>n</em> = 50; 53%), followed by (post-)coarctation pathology (<em>n</em> = 15; 16%). 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引用次数: 0

Abstract

Objective

Although thoracic endovascular aortic repair is the predominant treatment for most descending thoracic aorta (DTA) pathologies, a subset of patients remain unsuitable, leaving open surgical repair as their only viable option. This study reports the outcomes of open DTA repair performed in a high volume tertiary aortic referral centre.

Methods

Data on patients who underwent open repair for DTA pathology from 2013 to 2024 were collected retrospectively. Baseline characteristics, operative details, and post-operative outcomes were reviewed. The primary outcome was operative death; secondary outcomes included major adverse events (stroke, spinal cord ischaemia, tracheostomy, or dialysis).

Results

Among 337 patients who underwent open thoraco-(abdominal) aortic repair, 95 (55 men; 58%), with a mean age ± standard deviation of 56.1 ± 14.0 years, underwent isolated DTA repair (71 elective; 75%). The most common indication was post-dissection aneurysm (n = 50; 53%), followed by (post-)coarctation pathology (n = 15; 16%). Six (6%) patients were operated on for stent graft infection. The most frequent reasons for thoracic endovascular aortic repair ineligibility were absence of a proximal landing zone (n = 26; 27%), complex post-dissection anatomy (n = 19; 20%), infection (n = 13; 14%), and connective tissue disease (n = 13; 14%). Thirty day and operative mortality rates were both 3% (n = 3). The ninety day mortality rate was 6% (n = 5). Major complications included stroke (n = 1; 1%) and spinal cord ischaemia (n = 2; 2%; one transient paraparesis and one permanent paraplegia). No cases required tracheostomy or permanent dialysis. In hospital re-intervention was observed in 15% and acute kidney injury in 12% (including one patient requiring temporary dialysis). Mean follow up ± standard deviation was 49.0 ± 38.5 months. One and five year overall survival were 94.7% and 91.6%, respectively, and freedom from aortic related re-intervention was 96.8% and 94.7%, respectively.

Conclusion

In selected patients, open DTA repair may be required when endovascular treatment is unfeasible or considered inappropriate. In experienced centres, it yields very low mortality and complication rates and should therefore still be considered as part of the treatment armamentarium.

查看原文本刊更多论文

在血管内时代的胸降主动脉开放手术：单一中心的经验。

目的：尽管胸血管内主动脉修复是大多数胸降主动脉（DTA）病变的主要治疗方法，但仍有一部分患者不适合，将开放手术修复作为唯一可行的选择。本研究报告了在大容量三级主动脉转诊中心进行开放式DTA修复的结果。方法：回顾性收集2013年至2024年因DTA病理行开放式修复的患者资料。回顾了基线特征、手术细节和术后结果。主要结局为手术死亡率；次要结局包括主要不良事件（中风、脊髓缺血、气管切开术或透析）。结果：在337例接受开胸（腹）主动脉修复的患者中，95例（55例男性，58%）接受了孤立性DTA修复，平均年龄±标准差为56.1±14.0岁（n = 71, 75%为选择性）。最常见的指征是夹层后动脉瘤（n = 50, 53%），其次是（后）缩窄病理（n = 15, 16%）。6例（6%）患者因支架感染而接受手术。胸段血管内主动脉不适合修复的最常见原因是缺少近端着陆区（n = 26; 27%）、解剖后复杂的解剖结构（n = 19; 20%）、感染（n = 13; 14%）和结缔组织疾病（n = 13; 14%）。30天死亡率和手术死亡率均为3% （n = 3）。90天死亡率为6% （n = 5）。主要并发症包括中风（n = 1; 1%）和脊髓缺血（n = 2; 2%； 1例短暂截瘫和1例永久性截瘫）。没有病例需要气管切开术或永久性透析。院内再次干预占15%，急性肾损伤占12%（包括1例需要临时透析的患者）。平均随访±标准差为49.0±38.5个月。1年和5年总生存率分别为94.7%和91.6%，主动脉相关再干预自由度分别为96.8%和94.7%。结论：在选择的患者中，当血管内治疗不可行或不合适时，可能需要开放式DTA修复。在经验丰富的中心，它的死亡率和并发症发生率非常低，因此仍应被视为治疗手段的一部分。

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

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.