This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Wholly endovascular repair of thoracoabdominal aneurysm. BJS 2008; 95: 703-708.
Published: 29th April 2008
Authors: G. L. Gilling‐Smith, R. G. McWilliams, J. R. H. Scurr, J. A. Brennan, R. K. Fisher, P. L. Harris et al.
Background
The aim was to evaluate a wholly endovascular approach to the repair of thoracoabdominal aortic aneurysm (TAAA).
Method
Six patients (median age 71 years) underwent wholly endovascular repair of TAAA (maximum diameter 56–85 mm) employing individually customized endografts. Procedures were performed under general anaesthesia, with spinal drainage in five patients. Patients were followed by serial computed tomography, plain radiography and duplex imaging for a median of 17 (range 8–44) months.
Results
All grafts were deployed as intended, with preservation of all target vessels. There were no postoperative deaths, strokes or paraplegia. One patient suffered a silent myocardial infarction. In two patients a persistent paraostial endoleak was treated by further balloon dilatation of the stent within the endograft fenestration. Imaging before discharge confirmed aneurysm exclusion in all patients. Two patients required late secondary intervention to abolish endoleaks due to side‐branch disconnection. One patient suffered late occlusion of the coeliac axis without clinical sequelae, and late occlusion of a solitary renal artery in another resulted in dependence on dialysis. There have been no late deaths and all aneurysms remain excluded.
Conclusion
Wholly endovascular TAAA repair is relatively safe, but long‐term follow‐up is required to establish its durability. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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