title: Wholly endovascular repair of thoracoabdominal aneurysm.
abstract: BACKGROUND
  The aim was to evaluate a wholly endovascular approach to the repair of thoracoabdominal aortic aneurysm (TAAA).
  
  
  METHODS
  Six patients (median age 71 years) underwent wholly endovascular repair of TAAA (maximum diameter 56-85 mm) employing individually customized endografts. Procedures were performed under general anaesthesia, with spinal drainage in five patients. Patients were followed by serial computed tomography, plain radiography and duplex imaging for a median of 17 (range 8-44) months.
  
  
  RESULTS
  All grafts were deployed as intended, with preservation of all target vessels. There were no postoperative deaths, strokes or paraplegia. One patient suffered a silent myocardial infarction. In two patients a persistent paraostial endoleak was treated by further balloon dilatation of the stent within the endograft fenestration. Imaging before discharge confirmed aneurysm exclusion in all patients. Two patients required late secondary intervention to abolish endoleaks due to side-branch disconnection. One patient suffered late occlusion of the coeliac axis without clinical sequelae, and late occlusion of a solitary renal artery in another resulted in dependence on dialysis. There have been no late deaths and all aneurysms remain excluded.
  
  
  CONCLUSIONS
  Wholly endovascular TAAA repair is relatively safe, but long-term follow-up is required to establish its durability.
authors.affiliation: Regional Vascular Unit, Royal Liverpool University Hospital, Liverpool, UK. glgs@btinternet.com
authors.forename: G L
authors.initials: GL
authors.lastname: Gilling-Smith
authors.forename: R G
authors.initials: RG
authors.lastname: McWilliams
authors.forename: J R H
authors.initials: JR
authors.lastname: Scurr
authors.forename: J A
authors.initials: JA
authors.lastname: Brennan
authors.forename: R K
authors.initials: RK
authors.lastname: Fisher
authors.forename: P L
authors.initials: PL
authors.lastname: Harris
authors.forename: S R
authors.initials: SR
authors.lastname: Vallabhaneni
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004691:Endarterectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods