Southern Association for Vascular surgery
Spring 2022 Newsletter

Vascular Specialist

2007 Abstracts: Application of Endograft To Treat Thoracic Aortic Pathologies: A Single Center Experience

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Julio A Rodriguez
Arizona Heart Institute, Phoenix, AZ

Purpose: To evaluate our experience of thoracic endograft (ELG) repair of various thoracic aortic pathologies using a commercially available device recently approved by the FDA. Our patient population includes patients eligible for open surgical repair, as well as, those with prohibitive surgical risk.
Methods: From March 1998 to March 2006, endograft repair of the thoracic aorta was performed on 406 patients with 324 patients (median age 72; 200 male) receiving the Gore-Excluder endograft. Patient demographics, procedural characteristics, short- and mid-term follow-up were retrospectively reviewed. All patients were followed with ct-scan at 6 months and yearly.
Results: Three hundred twenty-four patients were treated with Gore Excluder graft between March 1998 and March 2006. One hundred fifty-seven patients (48.5%) had atherosclerotic aneurysms, 82 (25.3%) had dissections type B, 34 (10.5%) had penetrating ulcers, 26 (8.0%) with pseudoaneurysms, 11 (3.4%) had transections, 9 (2.8%) aorto-bronchial fistulas, 4 (1.2%) embolization, and 1 (0.3%) aorto-esophageal fistula. Preoperative aneurysm sac size ranged from 5 to 12 centimeters, average size 6.3cm. Average postoperative sac size of 5.4cm. Median operative time was 1.75 hours (range 0.75-6.25) with median estimated blood loss of 200cc (range 50 to 3500cc.) A single graft was used in 204 (65.1%) patients, 2 grafts in 87 (26.9 %), 3 or more grafts in 24 (7.4%). One hundred cases (31.5%) were emergent, 49 (15.1%) were ruptures. Additional procedures included 37 (10.9%) retroperitoneal approach, 37 (10.9%) covering/ ligation /coiling of the left subclavian, 8 (2.5%) thoracic debranching, 8 (2.5%) abdominal debranching, and 7 (2.2%) abdominal aortic aneurysm endoluminal graft repair. Median length of stay was 4 days (range 1-40).
Complications included 19 (5.9%) respiratory failure, 9 (2.8%) limb ischemia, 7 (2.2%) renal failure requiring hemodialysis, 7 (2.2%) cerebrovascular accidents, 5 (1.5%) bowel ischemia, 4 (1.2%) myocardial infarctions, and 1 (0.3%) graft migration following treatment of Ao-EF. Paraplegia occurred in 5 (1.5%) patients and paresis in 3 (0.9%), 2 of the latter improved and 1 resolved completely prior to discharge. Incidence of paraplegia was statistically significant (p-value<0.05) with retroperitoneal approach, perioperative blood loss greater than1000cc, and aortic coverage greater than 40cm. Thoracic aortic rupture occurred in 4 (1.2%) patients, 2 underwent open conversion. AAA rupture occurred in 3 (0.9%) patients, 2 during thoracic intervention and iliac artery rupture in 5 (1.5%) patients. Early endoleaks included 18 (5.5%) type I, 4 (1.2%) type II, and 2 (0.6%) type III. Thirty-day mortality was 5.5% (18 related deaths, including 3 intraoperative deaths).
Late endoleaks included 8 (2.5%) type I, 3 (0.9%) type II, and 2 (0.6%) type III. Late mortality was 9.6% with 31 unrelated deaths. Follow-up ranged between 1 month and 70 months, average 17 months.

Conclusions: After more than 300 cases, 30-day morbidity and mortality compares favorably with open repair. Paraplegia remains significantly low as a complication and increases in incidence with retroperitoneal approach, increased perioperative blood loss, and increased aortic coverage.

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