Deployment of balloon expandable stents during open repair of thoracoabdominal aortic aneurysms: a new strategy for managing renal and mesenteric artery lesions.
OBJECTIVE
Patients undergoing graft repair of thoracoabdominal aortic aneurysms (TAAAs) often require concomitant correction of ostial stenoses or dissection involving visceral branches. The purpose of this report is to describe our initial experience with a new strategy for addressing these lesions during open TAAA repair-direct deployment of balloon expandable stents into the renal and mesenteric arteries.


METHODS
Over a two-year period, 367 patients have undergone TAAA surgery. Balloon expandable stents were used to manage visceral branch lesions during open TAAA repair in 93 (25.3%) of these patients. Fifteen patients (16%) had preoperative renal insufficiency. After opening the aneurysm and exposing the branch artery ostia, premounted balloon expandable stents were deployed in the affected vessels under direct vision. Stents were deployed after an endarterectomy in 40 patients (43%). Eighty patients (86%) had stents placed in one or both renal arteries and 36 (39%) had stents placed in the celiac axis and/or superior mesenteric artery. Postoperative renal function was monitored with daily serum creatinine levels.


RESULTS
There were nine early operative deaths (10%). Two patients (2%) had bleeding complications related to stenting, one of which died after developing multiple organ failure. Twelve patients (13%) developed renal failure, eight of which required dialysis.


CONCLUSIONS
This study demonstrates the feasibility of treating ostial lesions of the visceral branches with balloon expandable stents during open TAAA repair. Despite a high prevalence of preoperative renal insufficiency, the incidence of postoperative renal failure was acceptable. This new strategy may be a valuable adjunct to TAAA repair and warrants further investigation.
Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine and The Methodist DeBakey Heart Center, 6560 Fannin Street, Suite 1100 Houston, TX 77030, USA. slemaire@bcm.tmc.edu
Scott A
SA
LeMaire
Autumn L
AL
Jamison
Stacey A
SA
Carter
Shixiang
S
Wen
Suresh
S
Alankar
Joseph S
JS
Coselli
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D002404:Catheterization; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000601:surgery*; D051437:Renal Insufficiency / Q000517:prevention & control; D015607:Stents; D016896:Treatment Outcome