The Long-term Fate of Renal and Visceral Vessel Reconstruction After Open Thoracoabdominal Aortic Aneurysm Repair.
In the ever-advancing era of endovascular thoracoabdominal aneurysm (TAAA) repair, understanding long-term patency of renovisceral reconstructions after open TAAA repair provides important benchmarks.Institutional open TAAA repair patient data were queried. Patients dying during index admission or with incomplete operative detail were excluded. Visceral and renal reconstructions were categorized as bypass, incorporation into a proximal or distal beveled aortic anastomosis, inclusion button, Carrel patch, or hybrid stent along with endarterectomy/stent adjuncts. Axial imaging or angiography determined long-term patency. Vessel event was defined as new occlusion or reintervention after repair. Overall time-to-event analysis was performed as well as separate analyses for each vessel (Celiac, SMA, right renal, left renal) by reconstruction type utilizing Kaplan-Meier methods. Log-rank testing was employed to compare reconstructive strategies.Over 28-years, 604 repairs [Type I 106(18%), Type II 73(12%), Type III 195(32%), Type IV 230(38%)] were identified. Follow-up (median 500 days) was available in 410/570(72%) Celiac, 406/573(71%) SMA, 379/532(71.2%) right renal, and 370/515(72%) left renal reconstructions. There were five celiac, one SMA, eight right renal, and ten left renal events. No type of reconstruction or adjunct was significantly associated with event. Overall 5-year patency of all renal/visceral reconstructions was 94% (95%CI [90%-96%]). Estimated 5-year patency of the Celiac, SMA, left renal, and right renal were similar, and were 99%, 100%, 97%, and 96%, respectively (p = .09).Visceral and renal long-term patency after open TAAA repair is excellent regardless of reconstructive technique. No differences are appreciated even when target vessel disease is addressed at the time of reconstruction. These findings continue to substantiate the effective long-term durability of open TAAA repair and are particularly germane to the ongoing evolution of endovascular strategies.
Authors: Jahan Mohebali, Christopher A Latz, Richard P Cambria, Virendra I Patel, Emel A Ergul, R Todd Lancaster, Mark F Conrad, W Darrin Clouse