Endovascular repair of postdissecting aneurysms safe for high-risk surgical patients

In a cohort of patients with postdissection aneurysms of the aortic arch or thoracoabdominal segment who were unfit for surgery, endovascular repair was a safe alternative, according to findings presented at the Society for Vascular Surgery Vascular Annual Meeting.

The researchers analyzed 39 patients (median age, 64 years) who had chronic postdissection aneurysms more than 55 mm in diameter and were treated by complex endografting between October 2011 and January 2017 after being deemed unfit for surgery.

Before the complex endovascular repair, in 74% of patients, staged management strategies such as left subclavian artery revascularization, thoracic endografting, dissection flap fenestration and tear enlargement were performed.

Outcomes of interest included technical success, endoleaks, target vessel patency, aneurysm diameter, major and minor complications, reinterventions and mortality. Median follow-up was 34.5 months.

The 39 patients underwent 42 procedures, including 18 arch repairs with inner branched endografts and 24 thoracoabdominal segment repairs with fenestrated or branched endografts, Rafaelle Spear, MD, PhD, from University of Lille, France, said during a presentation.

Technical success rate was 93%, median procedure time was 240 minutes and median X-ray time was 41.5 minutes, according to the researchers.

In-hospital mortality was 5% and 30-day mortality was 2.5%, Spear and colleagues reported.

There were three cases of spinal cord ischemia, from which one patient died and one patient fully recovered, according to the researchers.

Two patients required transient dialysis and six (14%) required early reintervention, three for access complications, two for acute hemorrhage and one for type II endoleak, Spear said.

During follow-up, three patients died from causes not related to their aneurysm.

Late reinterventions occurred in 18% of patients, and all target vessels remained patent during follow-up.

“Complex endovascular repair of postdissecting aneurysms is a safe alternative to open repair in patients deemed unfit for open surgery,” Spear and colleagues wrote in an abstract. “This technique is associated with a high rate of secondary procedures; cautious follow-up is, thus, required.” – by Erik Swain

Reference:

Spear R, et al. S7: Plenary Session 7. Presented at: Society for Vascular Surgery Vascular Annual Meeting; May 31-June 3, 2017; San Diego.

Disclosure: Spear reports no relevant financial disclosures.