Abstract
Objectives
In patients with abdominal aortic aneurysms, 10-20% have concomitant thoracic aortic
pathologies. These are typically managed with staged endovascular aneurysm repair
(EVAR) and thoracic endovascular aortic repair (TEVAR) due to a perceived higher risk
of spinal cord ischemia from a simultaneous intervention. We aimed to determine the
outcomes of patients undergoing simultaneous EVAR and TEVAR for concomitant aneurysms.
Methods
A retrospective cohort study was performed using the Vascular Quality Initiative registry
from December 2003 to January 2021. Patients undergoing same-day EVAR and TEVAR were
included and analyzed in accordance with the Society for Vascular Surgery reporting
standards. Primary outcomes were technical success and spinal cord ischemia.
Results
Simultaneous EVAR and TEVAR was performed in 25 patients. Median age was 75.0 (IQR
63.0-79.0) years and 20 (80.0%) patients were male. Two (4.0%) patients were symptomatic
and four (16.0%) presented with rupture. Median maximum infrarenal and thoracic aortic
diameter was 57.0 (IQR 52.0-65.0). Infrarenal aortic neck length was 15.0mm (IQR 10.0-25.0),
and diameter was 27.0mm (IQR 24.5-30.0). Median procedure time was 185.0 minutes (IQR,
117.8-251.3), fluoroscopy time 32.7 minutes (IQR, 21.8-63.1), and contrast volume
165 ml (IQR 115.0-207.0). There were three (12.0%) Type Ia endoleaks and three (12.0%)
Type II endoleaks in EVAR’s, with one (4.0%) Type Ia and one (4.0%) Type II endoleak
in TEVARs. In-hospital mortality occurred in three (12.0%) patients (one elective,
two ruptures). Spinal cord ischemia occurred in one (4.0%) patient. This patient had
a symptomatic aneurysm. Thoracic coverage extended from Zone 4 to Zone 5 and an emergent
spinal drain was placed postoperatively. Symptoms were present on discharge. There
was one (4.0%) conversion to open repair which occurred in a ruptured aneurysm. Technical
success was achieved in 19 (76.0%) patients, however when excluding ruptured aneurysms,
was achieved in 17 (81.0%) patients. Follow-up data was available for 19 (76.0%) patients
at a median of 426.0 (IQR 329.0-592.5) days postoperatively. A total of 3 (12.0%)
patients died during the late mortality period, at a mean of 509.0 (±503.7) days.
Median change in abdominal and thoracic aortic sac diameter was -1.35mm (IQR -11.5-2.5)
and 8.0 (IQR -10.5-12.0) respectively.
Conclusions
Simultaneous EVAR and TEVAR for concomitant abdominal and thoracic aortic aneurysms
can be performed with low rates of spinal cord ischemia. Short- and mid-term outcomes
are acceptable.
Key words
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Article Info
Publication History
Accepted:
June 23,
2022
Received in revised form:
June 21,
2022
Received:
March 9,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Presentation Information: Presented at the Society for Clinical Vascular Surgery 49th Annual Symposium, March 2022, Las Vegas, NV
Identification
Copyright
© 2022 Published by Elsevier Inc.
