Open vs. endovascular thoracoabdominal aortic aneurysm repair: tale of the tape

被引:6
|
作者
Cekmecelioglu, Davut [1 ,2 ,3 ]
Orozco-Sevilla, Vicente [1 ,2 ,3 ]
Coselli, Joseph S. [1 ,2 ,3 ,4 ]
机构
[1] Texas Heart Inst, Dept Cardiovasc Surg, Houston, TX 77025 USA
[2] Baylor Coll Med, Michael E DeBakey Dept Surg, Div Cardiothorac Surg, One Baylor Plaza,BCM 390, Houston, TX 77030 USA
[3] Baylor St Lukes Med Ctr, CHI St Lukes Hlth, Dept Cardiovasc Surg, Houston, TX USA
[4] Baylor Coll Med, Cardiovasc Res Inst, Houston, TX 77030 USA
来源
ASIAN CARDIOVASCULAR & THORACIC ANNALS | 2021年 / 29卷 / 07期
关键词
Aortic aneurysm; thoracic; endovascular procedures; patient selection; stent-graft; vascular grafting; REDUCES PARAPLEGIA; RENAL PERFUSION; CUSTOM-MADE; OUTCOMES; MANAGEMENT; SURGERY; EVAR; GUIDELINES; OPERATIONS; ENDOGRAFTS;
D O I
10.1177/0218492320949073
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Open surgical repair persists as the gold-standard operation for thoracoabdominal aortic aneurysm; however, endovascular repair has become commonplace. Technical considerations in thoracoabdominal aortic aneurysm treatment are particularly complex, insofar as it involves critical branching arteries feeding the visceral organs. Newer, low-profile devices make total endovascular thoracoabdominal aortic aneurysm repair more feasible and, thus, appealing. For younger and low-risk patients, the choice between open and endovascular therapy remains controversial. Despite the advantages of a minimally invasive procedure, data suggest that endovascular aortic repair incurs a greater risk of spinal cord deficit, and the durability of endovascular aortic repair remains unclear. It is difficult to compare outcomes between endovascular and open thoracoabdominal aortic aneurysm repair, primarily because of the current investigational status of endovascular devices, the variety of approaches to endovascular repair, differing patient populations, lack of prospective randomized studies, and minimal medium- and long-tern follow-up data on endovascular repair. When deciding between open and endovascular approaches, one should consider which is more suitable for each patient. Older patients generally benefit from a less invasive approach. Open repair should be considered for young patients and those with heritable thoracic aortic disease. Infection and fistulae are best treated by open repair, although endovascular intervention as a lifesaving bridge to definitive repair has evolved to become a critical component of initial treatment. It is crucial to have technical expertise in both open and endovascular procedures to provide the best aortic repair for the patient. This may require dedicated aortic programs at tertiary institutions.
引用
收藏
页码:643 / 653
页数:11
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