J.Jpn. Surg. Soc.. 115(2): 76-83, 2014

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Feature topic

CURRENT STATUS OF TOTAL ENDOVASCULAR TREATMENT FOR THORACOABDOMINAL AORTIC ANEURYSMS

The repair of thoracoabdominal aortic aneurysms (TAAAs) represents a considerable technical challenge. Open repair of TAAAs has been considered the gold standard. Despite improvements in surgical techniques, spinal cord protection, and postoperative critical care support, patients who undergo open repair are faced with a high mortality rate. Spinal cord ischemia is a well-known complication in the treatment of TAAAs. Cerebrospinal fluid drainage (CSFD) may increase the perfusion pressure to the spinal cord and hence reduce the risk of ischemic spinal cord injury. Open repair is performed in a standard procedure using a partial corporeal perfusion system, often with the use of CSFD. Endovascular repair procedures include the use of tailor-made branched endografts, customized fenestrated/branched endografts (Cook, Inc.), endografts with visceral artery coverage, and abdominal debranching with endografting. Stent-graft repair is one of the few treatment options in patients determined to be ineligible for surgery. The use of open repair for good-risk patients and selection of the fenestrated/branched endograft procedure for high-risk patients appear to lead to improved overall outcomes in the treatment of TAAAs. We report our experience in total endovascular treatment of TAAAs.

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