Total endovascular treatment for extent type 1 and 5 thoracoabdominal aortic aneurysms.

OBJECTIVE

The study objective was to describe the results of thoracic endovascular aortic repair with the intentional coverage of the celiac artery and distal supramesenteric landing zone for extent type 1 and type 5 thoracoabdominal aortic aneurysms.

METHODS

Inclusion criteria were thoracic endovascular aortic repair with celiac artery coverage to treat elective or urgent extent type 1 and 5 thoracoabdominal aortic aneurysms. Primary end points were in-hospital and follow-up survival, freedom from aortic-related mortality, and freedom from reintervention.

RESULTS

Thoracoabdominal disease extent was type 1 in 12 patients (71%) and type 5 in 5 patients (29%). Urgent repair was performed in 4 patients (23.5%). Primary technical success was 100%. Early mortality and visceral ischemia did not occur. Permanent spinal cord ischemia rate was 6% (n = 1). Follow-up ranged from 3 to 120 months (interquartile range, 12-36.5). Survival estimate was 85% ± 9% (95% confidence interval, 67-94) at 1 year and 49% ± 17% (95% confidence interval, 21-78) at 5 years. Cumulative freedom from aortic-related mortality was 94%, and estimated freedom from reintervention at 1 and 5 years was 93% ± 7% (95% confidence interval, 68-99). Neither type 1 endoleaks nor distal stent-graft migration causing superior mesenteric artery occlusion was detected.

CONCLUSIONS

Thoracic endovascular aortic repair with intentional coverage of celiac artery for extent 1 and 5 thoracoabdominal aortic aneurysms had satisfactory results in selected patients at high risk for open repair. Visceral ischemia did not occur, but spinal cord ischemia is still high at 6%. At midterm follow-up, neither endoleak development nor aortic reintervention was related to the inadequate distal landing zone. Follow-up survival is satisfactory and comparable to open repair.