Bulent KAYA, Kemalettin UÇANOK, Levent YAZICIOĞLU, Burak AÇIKGÖZ, Aycan KAVALA

The early- and mid-term results of our endovascular aneurysm repairs in thoracic aortic pathologies

Aim: Endovascular therapy can be an alternative option to open surgical treatment in high-risk patients with dissecting or pureaneurysmal dilation of aorta. Endovascular therapy is associated with less complication rates, as well as shorter hospital stay andfavourable blood products need perioperatively when compared to those in open surgical treatment. Our study aims to present asingle center experience by evaluating the early and midterm follow-up results of thoracic endovascular aortic repairs (TEVAR).Material and Methods: Nineteen patients who underwent TEVAR procedure between March 2005 and March 2011 were evaluatedretrospectively. Pre- and postoperative blood samples and computerized tomography angiograpy (CTA) results were compared. Thetype of stent graft used, need for blood product, postprocedural complications were evaluated.Results: The patients’ mean length of hospital stay was 12,8±6.5 days. The mean age was 56.1±8.7 years. Two patients (10.5%) wereurgently taken to operation; one of these (5.2%) was exitus on the postoperative day 7. None of the patients developed thromboembolicor neurological complication. Three patients (15.7%) developed endoleaks in their early-term follow-up whereas none hadendoleaks in their mid-term follow-up. There was a statistically significant difference between the preoperative and postoperativehemoglobin and hematocrit values of the patients (p

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1. Eggebrecht H, Lönn L, Herold U, et al. Endovascular stentgraft placement for complications of acute type B aortic dissection. Curr Opin Cardiol 2005;20:477-83.
2. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491-9.
3. Volodos NL, Karpovitch IP, Troyan VI. Clinical experience of the use of self- fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac arteries through the femoral reconstruction artery and as intraoperative endoprosthesis for aorta. Vasa Suppl 1991;33:93-5.
4. Şırlak M, Çakıcı M, İnan MB, et al. Torakal ve abdominal aort anevrizmalı hastalarda endovasküler stent ile onarım uygulamalarımız. Damar Cer Derg 2009;18:1-9.
5. Sancak T. Aortik endovasküler stent greft. Eren NT, ed. Aort Cerrahisi. Çağdaş Medikal Kitapevi, 2003:281-90
6. Bernhard VM, Mitchell RS, Matsumura JS, et al. Ruptured abdominal aortic aneurysm after endovascular repair. J Vasc Surg 2002;35:1155-62.
7. Lederle FA. Abdominal aortic aneurysm: open versus endovascular repair. N Engl J Med 2004;351:1677-9
8. Dake MD, Kato N, Scott MR, et al. Endovascular stent-graft placement fort he treatment of acute aort dissection. N Engl J Med 1999;340:1546-52.
9. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999;340:1539-45.
10. Rozenblit A, Marin ML, Veith FJ, et al. Endovascular repair of abdominal aortic aneurysm: Value of postoperative follow up with helical CT. Am J Roentgenol 1995;165:1473-9.
11. Bush RL, Mureebe L, Bohannon BT, et al. The impact of recent european trials on abdominal aortic aneurysm repair: Is a paradigm shift warranted? J Surg Research 2008;148:264-71.
12. Ouriel K. Randomised clinical trials of endovascular repair versus surveillance for treatment of small abdominal aortic aneurysms. J Endovasc Ther 2009;16:I94-I105.
13. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The tsk force for the diagnosis and treatment of aortic diseases of the european society of cardiology (ESC). Eur Heart J 2014;35:2873-926.
14. Riambau V, Böckler D, Brunkwall J, et al. Editor’s Choice – Management of descending thoracic aorta diseases: clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg 2017;53:4-52.
15. Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: Summary of opinions expressed at an international conference. J Vasc Surg 2002;35:1029-35.
16. Pearce BJ, Jordan WD. Using IVUS during EVAR and TEVAR:Improving patient outcomes. Semin Vasc Surg 2009;22:172-80.
17. Badri H, Haddad EM, Ashour H, et al. Duplex ultrasound scanning (DUS) versus computed tomography angiography (CTA) in the follow-up after evar. Angiology 2010;61:131-6.
18. Rayt HS, Sandford RM, Salem M, et al. Conservative management of Type 2 endoleaks is not associated with increased risk of aneurysm rupture. Eur J Vasc Endovasc Surg 2009;38:718-23.
19. Cheung AT, Pochettino A, McGarvey ML, et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg 2005;80:1280-9.
20. McGarvey ML, Mullen MT, Woo EY, et al. The treatment of spinal cord ischemia following thoracic endovascular aortic repair. Neurocrit Care 2007;6:35-9.
21. Weigang E, Parker JA, Czerny M, et al. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation? Eur J Cardiothorac Surg 2011;40:858-68.
22. Caronno R, Piffaretti G, Tozzi M, et al. Intentional coverage of the left subclavian artery during endovascular stent graft repair for thoracic aortic disease. Surg Endosc 2006;20:915- 8.
23. Geisbüsch P, Kotelis D, Hyhlik-Dürr A, et al. Endografting in the aortic arch – Does the proximal landing zone influence outcome? Eur J Vasc Endovasc Surg 2010;39:693-9.
24. Czerny M, Hoebartner M, Sodeck G, et al. The influence of gender on mortality in patients after thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2011;40:e1-5.
25. Chung J, Corriere MA, Veeraswamy RK, Kasirajan et al. Risk factors for late mortality after endovascular repair of the thoracic aorta. J Vasc Surg 2010;52:549-54.
26. Wang GC, Fairman RM, Jackson BM, et al. The outcome of thoracic endovascular aortic repair (TEVAR) in patients with renal insufficiency. J Vasc Surg 2009;49:42-6.
27. Huddle MG, Schlösser FJ, Dewan MC, et al. Can laboratory tests predict the prognosis of patients after endovascular aneurysm repair? Current status and future directions. Vascular 2009;17:129-37.
28. Dillavou ED, Makaroun MS. Predictors of morbidity and mortality with endovascular and open thoracic aneurysm. J Vasc Surg 2008;48:1114-9.
29. Arnaoutakis GJ, Hundt JA, Shah AS, et al. Comparative analysis of hospital costs of open and endovascular thoracic aortic repair. Vasc Endovascular Surg 2011;45:39-45.
30. Patel HJ, Williams DM, Upchurch GR Jr, et al. A comparative analysis of open and endovascular repair for the ruptured descending thoracic aorta. J Vasc Surg 2009;50:1265-70.
31. Patel HJ, Williams DM, Upchurch GR Jr, et al. A comparison of open and endovascular descending thoracic aortic repair in patients older than 75 years of age. Ann Thorac Surg 2008;85:1597-603.