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Redo Open and Endovascular Procedures after Open Thoraco-Abdominal Aortic Aneurysm Repair

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Thoraco-Abdominal Aorta

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Abstract

The outcomes of redo open repair for recurrent thoraco-abdominal aortic aneurysm (TAAA) are usually considered to be poorer when compared with the index procedure; for these reasons, less invasive strategies such as endovascular procedures are especially attractive. However, when the aneurysmal changes involve the visceral vessels such as in the case of visceral aortic patch (VAP) aneurysms, a conventional endovascular approach is not applicable. In this critical situation, a possible alternative to open regrafting is a hybrid treatment consisting of rerouting of visceral arteries, and aneurysm exclusion using commercially available thoracic aortic endografts. In this chapter, we compare the outcomes of our series of patients who, from 2001 to 2009, underwent redo VAP aneurysm open repair with a selected group of high-risk patients who underwent, in the same period, redo VAP aneurysm hybrid repair. We observed similar perioperative mortality and morbidity rates in the two groups of patients, with reduced surgical challenge in the hybrid group, allowing us to avoid redo-thoracotomy, retroperitoneal redissection, and previous thoracic graft reclamping. However, in the hybrid group, new medium-term specifically procedure-related complications have been observed and, until greater experience is available, a widespread use of this technique should currently be limited in this specific subset of high-risk patients.

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Author information

Authors and Affiliations

  1. Department of Vascular Surgery, “Vita-Salute” University, IRCCS H. San Raffaele, Milan, Italy

    Yamume Tshomba, Germano Melissano & Roberto Chiesa

Authors
  1. Yamume Tshomba
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  2. Germano Melissano
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  3. Roberto Chiesa
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Editors and Affiliations

  1. Department of Vascular Surgery, “Vita-Salute” University, IRCCS H., San Raffaele, Milan, Italy

    Roberto Chiesa , Germano Melissano  & Alberto Zangrillo ,  & 

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Tshomba, Y., Melissano, G., Chiesa, R. (2011). Redo Open and Endovascular Procedures after Open Thoraco-Abdominal Aortic Aneurysm Repair. In: Chiesa, R., Melissano, G., Zangrillo, A. (eds) Thoraco-Abdominal Aorta. Springer, Milano. https://doi.org/10.1007/978-88-470-1857-0_43

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  • DOI: https://doi.org/10.1007/978-88-470-1857-0_43

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1856-3

  • Online ISBN: 978-88-470-1857-0

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