Endovascular Repair for Thoracoabdominal Aortic Aneurysms
Thoracoabdominal aortic aneurysms (TAAA) are extremely burdensome to treat, due to their surgical complexity. In particular, postoperative spinal paraplegia poses severe complications that significantly lower patient QOL. Therefore, we focused on stent grafting, which is associated with a low incidence of postoperative paraplegia we devised a surgical procedure consisting of extended endovascular aortic repair (EVAR) and an abdominal visceral bypass. This presentation reports on the positive results attained from this procedure. 542 EVARs were conducted between January 1997 and September 2007. Among these, we selected 64 cases of TAAA, of which 38 were Crawford type I, 11 were Crawford type II, and 15 were Crawford type III. The average age of patients was 74.6 years. Preoperative complications included 8 cases of cerebrovascular damage, 7 cases of CAD, 8 cases of COPD. For spinal cord protection, Cerebrospinal fluid drainage and dosage of naloxone was initiated during the operation. Of Crawford I patients, we inserted stent grafts above the celiac artery in 25 of these cases, and above SMA with sacrifice of the celiac artery in 13 cases. For Crawford II, III patients, we performed bypassing from the aortic bifurcation to abdominal visceral arteries before deploying the stent graft. Operative time averaged 86 minutes for EVAR only and 328 minutes with bypass. There was no death and only a single case of graft occlusion. There were no cases of endoleak, and 47 cases shrinked aneurysms. Furthermore, not a single patient exhibited paraplegia and delayed paraplegia. In conclusion, we obtained satisfying results by EVAR for TAAA. Even though sufficient follow-up is needed for visceral bypasses, the procedure might be one of the standard surgeries for thoracoabdominal aortic aneurysms.