- Email: [email protected]
Open Surgery of Thoracoabdominal Aneurysms in the Era of Branched Stentgrafts
Vol. 28, No. 6, August 2014
reconstruction of the renal and/or visceral arteries. The approach was retroperitoneal in 51.8% of the cases (n¼29) and transperitoneal in 48.2% of the cases (n¼27). Clamping was supra-renal in 71.4% of the cases (n¼40) and supra-visceral in 28.6% of the cases (n¼16). The median duration of renal clamping was 29.5 min [1550]. Postoperative impaired renal function was observed in 37.5% of the patients (n¼21). Only one patient (1.8%) necessitated temporary dialysis. Respiratory complications (pneumopathy, acute respiratory insufficiency, reintubation) were observed in 14.3% of the patients (n¼8). No patient had postoperative paraplegia or occlusion of the renal or visceral arteries. Six patients (10.7%) had a re-implantation of the lower mesenteric artery. Overall survival rate was 85.2% at two years and 75.2% at five years. Duration of clamping higher than 30 min was significantly associated with an increased mortality at 2.5 and 7 years. Conclusion: The morbi-mortality of conventional surgery for JR-AAA is similar to that of infrarenal AAA provided that the duration of supra-renal clamping remains < 30 min, with very satisfactory long-term results. The conventional surgery of JR-AAA does not require a reconstruction of the renal or visceral arteries contrary to fenestrated stentgrafts.
29th Annual Meeting, French Society for Vascular Surgery (SCV) 1369
carried out in 43 cases (55.8%). A systematic drainage of the LCR was possible in 48 cases (62%). The mean duration of clamping and ECC were 51±25 min and 58±25 min, respectively. Mortality at 30 days and in-hospital mortality were 3.9% (n¼3) and 6.5% (n¼5), respectively. The post-operative rate of paraplegia was 3.9% (n¼3). Six patients necessitated a postoperative dialysis, including three with an end stage renal failure (3.9%). Pulmonary complications were observed in 22 patients (28.6%), and 15 surgical reinterventions were necessary (19.5%). The median duration of stay in reanimation and of hospitalization was 5 days (1 to 82) and 16 days (6 to 120), respectively. The only significant predictive factor of mortality found by uniand multivariate analysis was a preoperative glomerular filtration rate <60mL/min (OR¼12). Conclusion: Performed in a center of expertise, in selected patients, open surgery of TAA with assistance ECC present satisfactory results in the short run. These updated results can be used as a reference for the treatment of TAA, in the era of the indications for branched stentgrafts or hybrid techniques. http://dx.doi.org/10.1016/j.avsg.2014.06.038
http://dx.doi.org/10.1016/j.avsg.2014.06.054
Open Surgery of Thoracoabdominal Aneurysms in the Era of Branched Stentgrafts Marc Dennery, Jean-Marc Alsac, Marwan Abou Rjeili, Salma El Batti, Paul Achouh, Pierre Julia, and Jean-No€el Fabiani Service de chirurgie cardiovasculaire, H^opital Europeen Georges Pompidou, Paris, France. Objectives: Whereas the first short-term results of the endovascular treatment by branched stentgrafts of thoracoabdominal aneurysms (TAA) are reported, the aim of this study was to evaluate the current results of open surgery in a center of reference. Materials and Methods: The demographic and perioperative data of consecutive patients operated between 2006 and 2013 for a TAA of type I, II and III, were analyzed retrospectively. All the patients included were operated by thoraco-phreno-lombotomy with an assistance extracorporeal circulation (ECC). The principal criteria of evaluation were intra-hospital mortality and paraplegia. Their predictive factors were sought by uni- and multivariate analyzes. Results: A total of 77 patients (mean age 59±14 years, 80.5% of men) were operated for TAA (I: 24, II: 18, III: 35), complicating a dissection in 27 cases (35.1%), or a syndrome of Marfan in eight cases (10.4%). The location of the artery of Adamkiewicz was possible in 28 cases (36%), and a re-implantation of intercostal arteries was
Compilations of Chimney Techniques and Fenestrated Stentgrafts in the Treatment of Juxta-renal Aneurysms Julien Morin, Vicenzo Brizzi, Xavier Berard, Dominique Midy, and Eric Ducasse Service de chirurgie vasculaire, CHU de Bordeaux, Bordeaux, France. Objectives: To evaluate the technical feasibility and the short-term results of the endovascular treatment of paraor juxtarenal aneurysms of the abdominal aorta associating chimney technics and fenestrated stentgrafts according to anatomical indications and/or specific accesses. Materials and Methods: The management of juxtarenal aneurysms is classically carried out with fenestrated stentgrafts in elective surgery. However, a certain number of patients profited from the deployment of a fenestrated stentgraft (standard and home-made) associated with one or more revascularizations of a target artery (renal and/or visceral) by a chimney technique between 2011 and 2014 in our unit. All the patients were followed-up by CT and echography-Doppler during the hospitalization and up to three months. Results: There were 18 patients (16 men - 89%), with a mean age of 71.7 years. The average diameter of aneurysms was 62.6 mm. Fifty-four target arteries were treated (i.e. three arteries per patient) by 30 windows (12 scallops, 6 home-made, 12 standards) and 24 chimneys (11 open and 13 covered). The superior mesenteric arteries were revascularized by 12 scallops and four open chimneys, the right renal arteries by 13 chimneys (4 open, 9 covered)
reconstruction of the renal and/or visceral arteries. The approach was retroperitoneal in 51.8% of the cases (n¼29) and transperitoneal in 48.2% of the cases (n¼27). Clamping was supra-renal in 71.4% of the cases (n¼40) and supra-visceral in 28.6% of the cases (n¼16). The median duration of renal clamping was 29.5 min [1550]. Postoperative impaired renal function was observed in 37.5% of the patients (n¼21). Only one patient (1.8%) necessitated temporary dialysis. Respiratory complications (pneumopathy, acute respiratory insufficiency, reintubation) were observed in 14.3% of the patients (n¼8). No patient had postoperative paraplegia or occlusion of the renal or visceral arteries. Six patients (10.7%) had a re-implantation of the lower mesenteric artery. Overall survival rate was 85.2% at two years and 75.2% at five years. Duration of clamping higher than 30 min was significantly associated with an increased mortality at 2.5 and 7 years. Conclusion: The morbi-mortality of conventional surgery for JR-AAA is similar to that of infrarenal AAA provided that the duration of supra-renal clamping remains < 30 min, with very satisfactory long-term results. The conventional surgery of JR-AAA does not require a reconstruction of the renal or visceral arteries contrary to fenestrated stentgrafts.
29th Annual Meeting, French Society for Vascular Surgery (SCV) 1369
carried out in 43 cases (55.8%). A systematic drainage of the LCR was possible in 48 cases (62%). The mean duration of clamping and ECC were 51±25 min and 58±25 min, respectively. Mortality at 30 days and in-hospital mortality were 3.9% (n¼3) and 6.5% (n¼5), respectively. The post-operative rate of paraplegia was 3.9% (n¼3). Six patients necessitated a postoperative dialysis, including three with an end stage renal failure (3.9%). Pulmonary complications were observed in 22 patients (28.6%), and 15 surgical reinterventions were necessary (19.5%). The median duration of stay in reanimation and of hospitalization was 5 days (1 to 82) and 16 days (6 to 120), respectively. The only significant predictive factor of mortality found by uniand multivariate analysis was a preoperative glomerular filtration rate <60mL/min (OR¼12). Conclusion: Performed in a center of expertise, in selected patients, open surgery of TAA with assistance ECC present satisfactory results in the short run. These updated results can be used as a reference for the treatment of TAA, in the era of the indications for branched stentgrafts or hybrid techniques. http://dx.doi.org/10.1016/j.avsg.2014.06.038
http://dx.doi.org/10.1016/j.avsg.2014.06.054
Open Surgery of Thoracoabdominal Aneurysms in the Era of Branched Stentgrafts Marc Dennery, Jean-Marc Alsac, Marwan Abou Rjeili, Salma El Batti, Paul Achouh, Pierre Julia, and Jean-No€el Fabiani Service de chirurgie cardiovasculaire, H^opital Europeen Georges Pompidou, Paris, France. Objectives: Whereas the first short-term results of the endovascular treatment by branched stentgrafts of thoracoabdominal aneurysms (TAA) are reported, the aim of this study was to evaluate the current results of open surgery in a center of reference. Materials and Methods: The demographic and perioperative data of consecutive patients operated between 2006 and 2013 for a TAA of type I, II and III, were analyzed retrospectively. All the patients included were operated by thoraco-phreno-lombotomy with an assistance extracorporeal circulation (ECC). The principal criteria of evaluation were intra-hospital mortality and paraplegia. Their predictive factors were sought by uni- and multivariate analyzes. Results: A total of 77 patients (mean age 59±14 years, 80.5% of men) were operated for TAA (I: 24, II: 18, III: 35), complicating a dissection in 27 cases (35.1%), or a syndrome of Marfan in eight cases (10.4%). The location of the artery of Adamkiewicz was possible in 28 cases (36%), and a re-implantation of intercostal arteries was
Compilations of Chimney Techniques and Fenestrated Stentgrafts in the Treatment of Juxta-renal Aneurysms Julien Morin, Vicenzo Brizzi, Xavier Berard, Dominique Midy, and Eric Ducasse Service de chirurgie vasculaire, CHU de Bordeaux, Bordeaux, France. Objectives: To evaluate the technical feasibility and the short-term results of the endovascular treatment of paraor juxtarenal aneurysms of the abdominal aorta associating chimney technics and fenestrated stentgrafts according to anatomical indications and/or specific accesses. Materials and Methods: The management of juxtarenal aneurysms is classically carried out with fenestrated stentgrafts in elective surgery. However, a certain number of patients profited from the deployment of a fenestrated stentgraft (standard and home-made) associated with one or more revascularizations of a target artery (renal and/or visceral) by a chimney technique between 2011 and 2014 in our unit. All the patients were followed-up by CT and echography-Doppler during the hospitalization and up to three months. Results: There were 18 patients (16 men - 89%), with a mean age of 71.7 years. The average diameter of aneurysms was 62.6 mm. Fifty-four target arteries were treated (i.e. three arteries per patient) by 30 windows (12 scallops, 6 home-made, 12 standards) and 24 chimneys (11 open and 13 covered). The superior mesenteric arteries were revascularized by 12 scallops and four open chimneys, the right renal arteries by 13 chimneys (4 open, 9 covered)