Early Australasian experience with branched endovascular thoracoabdominal aortic aneurysm repair.
BACKGROUND
Endovascular technology can now support total endovascular thoracoabdominal aortic aneurysm repair with branches maintaining visceral and renal perfusion thus avoiding the need for massive open surgery. High-volume centres have reported encouraging results. We report our Australasian experience of 10 cases including the first-in-man 'off-the-shelf' graft.


METHODS
Ten consecutive endovascular repairs performed with prospective data collection have been retrospectively analysed.


RESULTS
Six men and four women with an average age of 72.4 years (range 55-85) were treated between 2009 and 2012. The mean aneurysm diameter was 7 cm (range 4.8-10.0) with aneurysms across all five Crawford classifications. One hundred per cent procedural technical success was achieved and all branches and fenestrations were patent at a median follow up of 12 months. In total, 30 branches were utilized together with seven fenestrations. One death from respiratory failure occurred on day 30 without endograft problems and there were two late aneurysm related deaths. Three patients experienced spinal cord ischaemia and one patient experienced two separate late endoleaks. Six patients had successful endografts and remain alive and well.


CONCLUSIONS
For experienced endovascular surgeons working with a proctor 100% technical success in graft deployment is achievable. Endovascular skills alone do not guarantee long-term success; our results demonstrate the need for careful patient selection, the danger of spinal cord ischaemia and the potential for endoleaks.
Department of Vascular Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.
Russell W
RW
Jamieson
Ravi L
RL
Huilgol
D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D044362:Australasia; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D057867:Endoleak / Q000453:epidemiology; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000453:epidemiology
aortic aneurysm; endovascular; fenestrated; thoracoabdominal; vascular surgery