Open aortic surgery after thoracic endovascular aortic repair.
In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA. jcoselli@bcm.edu.|Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA. jcoselli@bcm.edu.|CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA. jcoselli@bcm.edu.
Joseph S
JS
Coselli
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA.|Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.|CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA.
Konstantinos
K
Spiliotopoulos
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA.|Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.|CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA.
Ourania
O
Preventza
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA.|Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.|CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA.
Kim I
KI
de la Cruz
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA.|Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.
Hiruni
H
Amarasekara
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA.|Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.
Susan Y
SY
Green
D000784:Aortic Dissection / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D057867:Endoleak / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Aortic aneurysm; Descending thoracic aorta; Open surgical repair; Thoracic endovascular aortic repair