Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience
Objective: Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated. Methods: This wa...
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Elsevier
2025-01-01
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| Series: | EJVES Vascular Forum |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666688X24001588 |
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| author | Yutaka Iba Tomohiro Nakajima Junji Nakazawa Tsuyoshi Shibata Shuhei Miura Nobuyoshi Kawaharada |
| author_facet | Yutaka Iba Tomohiro Nakajima Junji Nakazawa Tsuyoshi Shibata Shuhei Miura Nobuyoshi Kawaharada |
| author_sort | Yutaka Iba |
| collection | DOAJ |
| description | Objective: Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated. Methods: This was a retrospective and observational study. From January 2010 to June 2022, 20 patients who underwent open aortic repair after TEVAR were included. The indications for open conversion surgery were as follows: aortic enlargement due to endoleak (EL) in seven patients (type Ia: n = 4, type II: n = 1, type V: n = 2; 35%), stent graft infection including aorto-oesophageal fistula (AEF) in six (30%), retrograde type A aortic dissection (RTAD) in three (15%), and dilatation of adjacent distal aorta or false lumen in four (20%). Results: Seven patients with type Ia EL or RTAD required open aortic arch repair. Four underwent thoraco-abdominal aortic repair for distal aortic enlargement. Descending thoracic aortic replacement was performed in all six infection cases and two patients with type V EL. Furthermore, three patients with AEF received concomitant oesophagectomy. One patient with persistent type II EL underwent intercostal artery ligation and aneurysmorrhaphy via thoracotomy. There were two in hospital deaths (10%), all with AEF. Thus, the rates of in hospital death were 0% in non-infected cases, 33% in graft infections, with 66% in those with AEF. Stroke and paraplegia were observed in two patients (10%). Conclusion: When open conversion surgery is required after TEVAR, the indications are complex, often associated with infectious pathology, and are necessarily high risk particularly in patients with AEF. Surgical strategy has to be individualised based on the nature or cause of the complication and extent of aortic involvement. |
| format | Article |
| id | doaj-art-a1fdc114ad86492998e88bb8dae43ff0 |
| institution | DOAJ |
| issn | 2666-688X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Vascular Forum |
| spelling | doaj-art-a1fdc114ad86492998e88bb8dae43ff02025-08-20T03:23:06ZengElsevierEJVES Vascular Forum2666-688X2025-01-0163324010.1016/j.ejvsvf.2024.12.001Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical ExperienceYutaka Iba0Tomohiro Nakajima1Junji Nakazawa2Tsuyoshi Shibata3Shuhei Miura4Nobuyoshi Kawaharada5Corresponding author. Department of Cardiovascular Surgery, Sapporo Medical University, 291, South 1, West 17, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.; Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, JapanObjective: Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated. Methods: This was a retrospective and observational study. From January 2010 to June 2022, 20 patients who underwent open aortic repair after TEVAR were included. The indications for open conversion surgery were as follows: aortic enlargement due to endoleak (EL) in seven patients (type Ia: n = 4, type II: n = 1, type V: n = 2; 35%), stent graft infection including aorto-oesophageal fistula (AEF) in six (30%), retrograde type A aortic dissection (RTAD) in three (15%), and dilatation of adjacent distal aorta or false lumen in four (20%). Results: Seven patients with type Ia EL or RTAD required open aortic arch repair. Four underwent thoraco-abdominal aortic repair for distal aortic enlargement. Descending thoracic aortic replacement was performed in all six infection cases and two patients with type V EL. Furthermore, three patients with AEF received concomitant oesophagectomy. One patient with persistent type II EL underwent intercostal artery ligation and aneurysmorrhaphy via thoracotomy. There were two in hospital deaths (10%), all with AEF. Thus, the rates of in hospital death were 0% in non-infected cases, 33% in graft infections, with 66% in those with AEF. Stroke and paraplegia were observed in two patients (10%). Conclusion: When open conversion surgery is required after TEVAR, the indications are complex, often associated with infectious pathology, and are necessarily high risk particularly in patients with AEF. Surgical strategy has to be individualised based on the nature or cause of the complication and extent of aortic involvement.http://www.sciencedirect.com/science/article/pii/S2666688X24001588Aortic AneurysmAortic DissectionComplicationThoracic Endovascular Aneurysm Repair |
| spellingShingle | Yutaka Iba Tomohiro Nakajima Junji Nakazawa Tsuyoshi Shibata Shuhei Miura Nobuyoshi Kawaharada Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience EJVES Vascular Forum Aortic Aneurysm Aortic Dissection Complication Thoracic Endovascular Aneurysm Repair |
| title | Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience |
| title_full | Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience |
| title_fullStr | Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience |
| title_full_unstemmed | Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience |
| title_short | Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience |
| title_sort | open aortic repair after thoracic endovascular aortic repair strategic insights from a single centre surgical experience |
| topic | Aortic Aneurysm Aortic Dissection Complication Thoracic Endovascular Aneurysm Repair |
| url | http://www.sciencedirect.com/science/article/pii/S2666688X24001588 |
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