Objective
This study reports on open TAAA repair comparing short and long term patient outcome
according to the type of repair defined by the Crawford classification and elective
vs. emergency repair. Endpoints were death, acute kidney injury (AKI), sepsis, spinal
cord ischaemia (SCI), and re-intervention rate.
Methods
This was a retrospective study reporting the outcomes of 255 patients (between 2006
and 2019), designed according to the STROBE criteria.
Results
The TAAA distribution was type I 25%, type II 26%, type III 23%, type IV 18%, and
type V 7%. Fifty-one (20%) patients had an emergency procedure. Of all the patients,
51% had a history of aortic surgery, 58% suffered from post-dissection TAAA, and 26%
had connective tissue disease. The in hospital mortality rate among electively treated
patients was 16% (n = 33) vs. 35% (n = 18) in the emergency subgroup; the total mortality rate was 20% (n = 51). The adjusted odds ratio for in hospital death following emergency repair compared
with elective repair was 2.52 (95% confidence interval [CI] 1.15 – 5.48). Temporary
renal replacement therapy because of AKI was required in 29% (n = 74) of all patients, sepsis from different cause was observed in 37% (n = 94), and SCI in 7% (n = 18, 10 patients suffering from paraplegia and eight from paraparesis). The mean
follow up time was 3.0 years (median 1.5, range 0 – 12.8 years). Aortic related re-intervention
was required in 2.8%. The total mortality rate during follow up was 22.5% (n = 46); 5.3% (n = 11) of all patients died because of aortic related events.
Conclusion
Open TAAA repair is associated with an important morbidity and mortality rate, yet
the incidence of spinal cord ischaemia may be favourably low if a neuromonitoring
protocol is applied. The aortic related re-intervention and aortic related mortality
rate during follow up are low.
Keywords
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Article info
Publication history
Published online: March 18, 2022
Accepted:
February 1,
2022
Received:
September 14,
2021
Identification
Copyright
© 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary on “Outcome of Elective and Emergency Open Thoracoabdominal Aortic Aneurysm Repair in 255 Cases - A Retrospective Single Centre Study”European Journal of Vascular and Endovascular SurgeryVol. 63Issue 4
- PreviewThe open repair of a thoraco-abdominal aortic aneurysm (TAAA) is possibly one of the greatest surgical challenges. The pioneering work of E.S. Crawford and of the “Houston School” showed that the operation is feasible but that it carries a significant risk of mortality, as well as morbidity, with paraplegia being the most dreaded complication.
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