title: Editor's Choice - Ten-year Experience with Endovascular Repair of Thoracoabdominal Aortic Aneurysms: Results from 166 Consecutive Patients.
abstract: OBJECTIVE
  To present a 10 year experience with endovascular thoracoabdominal aortic aneurysm (TAAA) repair using fenestrated and branched stent grafts.
  
  
  METHODS
  Consecutive patients with TAAA treated with fenestrated and branched stent grafts within the period January 2004-December 2013. Data were collected prospectively.
  
  
  RESULTS
  166 patients (125 male, 41 female, mean age 68.8 ± 7.6 years) were treated. The mean TAAA diameter was 71 ± 9.3 mm. Types of TAAA were: type I, n = 12 (7.2%), type II, n = 50 (30.1%), type III, n = 53 (31.9%), type IV, n = 41 (24.8%), and type V, n = 10 (6%). Fifteen (9%) patients had an acute TAAA (11 contained rupture, 4 symptomatic). One hundred and eight (65%) patients were refused for open surgery earlier. Seventy eight (47%) patients had previously undergone one or more open/endovascular aortic procedures. Technical success was 95% (157/166). Thirty day operative mortality was 7.8% (13/166), with an in hospital mortality of 9% (15/166). Peri-operative spinal cord ischemia (SCI) was observed in 15 patients (9%), including permanent paraplegia in two (1.2%). Mean follow up was 29.2 ± 21 months. During follow up 40 patients died, two of them probably from aneurysm related cause. Re-intervention, mostly by endovascular means, was needed in 40 (24%) patients. Estimated survival at 1, 2, and 5 years was 83% ± 3%, 78% ± 3.5%, and 66.6% ± 6.1%, respectively. Estimated target vessel stent patency at 1, 2, and 5 years was 98% ± 0.6%, 97% ± 0.8%, and 94.2% ± 1.5%, respectively. Estimated freedom from re-intervention at 1 and 3 years was 88.3% ± 2.7%, and 78.4% ± 4.5%, respectively.
  
  
  CONCLUSIONS
  Endovascular repair of TAAA with fenestrated and branched stent grafts in high volume centers appears safe and effective in the mid-term in a high risk patient cohort. A considerable reintervention rate should be acknowledged, however.
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nürnberg, Germany. Electronic address: eric.verhoeven@klinikum-nuernberg.de.
authors.forename: E L G
authors.initials: EL
authors.lastname: Verhoeven
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nürnberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Katsargyris
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Bekkema
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nürnberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Oikonomou
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: C J A M
authors.initials: CJ
authors.lastname: Zeebregts
authors.affiliation: Department of Radiology, Paracelsus Medical University, Nürnberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Ritter
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: I F J
authors.initials: IF
authors.lastname: Tielliu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
keywords: Aortic aneurysm; Branched; Endovascular repair; Fenestrated; Thoracoabdominal