title: Endovascular repair of thoracoabdominal aneurysms: results of the first 48 cases.
abstract: BACKGROUND
  In 2006, we began our experience with a novel technology for fully endovascular thoracoabdominal aneurysm repair, based on a custom-made, branched stent graft design. After 48 cases, we have learned and achieved substantial progress both in technical and in clinical skills. This paper describes the partial results of this ongoing experience.
  
  
  METHODS
  Patients in this series were selected for the presence of thoracoabdominal aortic aneurysms, with or without dissection, which was present in one patient. The observation of extensive anatomical variations in several patients prompted changes in many of the basic stent graft configurations, which are also described.
  
  
  RESULTS
  Between August 2006 and June 2012, 48 patients were treated consecutively with custom-made branch stent grafts. The five patients with the longest follow-up available so far are at 71, 65, 60, 54 and 51 months post-procedure. The operative mortality rate, defined as death during or within a month of surgical hospitalization, was 21% (10 patients); each case is described herein. During postoperative follow up, nine patients died from causes not directly related to aneurysmal disease, at 3, 18, 20, 22, 24, 24, 37, 44 and 46 months. The main causes of death were myocardial infarction (four cases), cancer (two cases), gastrointestinal hemorrhage (one case), ischemic stroke (one case), and sepsis (one case). Permanent paraplegia occurred in one patient.
  
  
  CONCLUSIONS
  It is still too soon to compare the results of endovascular repair of thoracoabdominal aneurysms with those of open surgical series. Despite the active and rapid progress currently observed for the endovascular method, it is still far from reaching its state-of-the-art plateau or becoming a gold standard. Further technological and technical advances in endovascular stent grafting seem to have a clear potential to provide very satisfactory operative outcomes for thoracoabdominal aortic aneurysms.
authors: Serviço Integrado de Técnicas Endovasculares (SITE), Rua Siqueira Campos, 59, 203, Rio de Janeiro, RJ, Brazil.
authors: Marcelo
authors: M
authors: Ferreira
authors: Luiz
authors: L
authors: Lanziotti
authors: Rodrigo
authors: R
authors: Cunha
authors: Guilherme
authors: G
authors: d'Utra
keywords: Aortic aneurysm; endovascular procedures; stents; thoracoabdominal
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