Midterm Outcomes for Endovascular Repair of Thoraco-Abdominal Aortic Aneurysms

Abstract

Objective: To investigate technical and clinical outcomes in patients with thoraco-abdominal aortic aneurysms treated with the multibranched off the shelf Zenith t-Branch stent graft or a custom made device (CMD). Methods: A retrospective study was conducted of patients operated on at a single tertiary vascular centre in Norway. Twenty eight t-Branch and 17 CMD patients were identified. Demographic, aneurysm, and peri-operative data were summarised and compared. Results: Thirty day mortality was 4% (2/45), with mortality rates of 7% (2/28) and 0 in t-Branch and CMD patients, respectively (p = .52). Technical success was 87% (39/45), with a non-significant difference between t-Branch and CMD procedures of 89% (25/28) and 82% (14/17), respectively (p = .63). Stent graft coverage was significantly longer in t-Branch patients (p = .020). Paraparesis or paraplegia developed in 18% (5/28) of t-Branch patients and 12% (2/17) of CMD patients (p = .69), and spinal cord ischaemia was associated with Crawford type II aneurysms (p = .010) and aortic coverage >400 mm (p = .050). The estimated survival at one and two years for t-Branch patients was 93% and 88%, and 100% and 92% for CMD patients. Freedom from re-intervention was estimated at 70% and 43% at one and two years for t-Branch patients, and 58% and 50% for CMD patients. Conclusion: The study showed low 30 day mortality rates, acceptable technical success rates, high medium term survival, and no statistically significant differences in clinically relevant outcomes between t-Branch and CMD patients.

Keywords

• Aortic disease
• Endovascular therapy
• Follow up
• Spinal cord ischaemia
• Thoraco-abdominal aortic aneurysm