Secondary Open Aortic Surgery After Thoracic Endovascular Aortic Repair: Surgical Strategy and Clinical Problems.

P0295 

Abstract Submission 

Yutaka Iba (1), Tomohiro Nakajima (1), Junji Nakazawa (1), Tsuyoshi Shibata (1), Shuhei Miura (1), Ayaka Arihara (1), Takakimi Mizuno (1), Keitaro Nakanishi (1), Kei Mukawa (1), Nobuyoshi Kawaharada (1)

(1) Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan

Yutaka Iba    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Tomohiro Nakajima    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Junji Nakazawa    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Tsuyoshi Shibata    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Shuhei Miura    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Ayaka Arihara    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Takakimi Mizuno    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Keitaro Nakanishi    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Kei Mukawa    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Nobuyoshi Kawaharada    -  Contact Me
Department of Cardiovascular Surgery, Sapporo Medical University

Yutaka Iba    -  Contact Me
N/A

Objective: Thoracic endovascular aortic repair (TEVAR) is becoming more widely used in aortic surgery due to its minimally invasive nature, which does not require thoracotomy. However, some patients require secondary open aortic repair for various reasons, so the surgical strategy and the management of endoprosthesis in such situation are still controversial.
Methods: From January 2012 to December 2022, twenty patients who underwent secondary open aortic repair for the same or adjacent site after TEVAR were included. Indications for secondary open aortic repair are aneurysmal dilatation due to endoleaks (type Ia: n=4, Type II: n=1, Type V: n=2), Infection of stentgraft (n=6), enlargement of distal aorta or false lumen (n=4), and retrograde type A aortic dissection (RTAD) (n=3). Six patients who required open conversion for type Ia endoleaks or RTAD received aortic arch replacement while its distal anastomosis was done to the fully or partially preserved prior stentgraft. Four patients underwent thoracoabdominal aortic repair for enlargement of distal aorta or the false lumen of chronic aortic dissection, and three of them were performed proximal anastomosis to the prior stentgraft. Six patients of stentgraft infection underwent the removal of stentgraft and descending thoracic aortic (DTA) replacement. In addition, three of such patients had aorto-esophageal fistula (AEF), and esophagectomy were simultaneously performed. One patient with chronic aortic dissection was required aortic arch and DTA replacement with full extraction of prior endoprosthesis due to the growth of the false lumen. Two patients with type V endoleak was received DTA replacement with partially or complete extraction of stentgraft, and the other with the dilatation of DTA aneurysm due to persistent type II endoleak underwent the ligation of intercostal artery and aneurysmorrhaphy with thoracotomy.
Results: There were two early mortality (10%). One died of sepsis from persistent infection in patient with stentgraft infection and AEF, the other from sudden arrhythmia. Stroke was observed in 2 cases (10%), paraplegia occurred in 2 cases (10%), and paraparesis also developed in 2 cases (10%). Tracheostomy was required in 3 cases (15%), all with AEF. Mean in-hospital day was 46 ± 25 days.
Conclusions: Secondary open aortic repair after TEVAR may be required for various reasons and pathologies, however, the operative outcomes of this open conversion surgery seem to be acceptable, except for those in AEF. Previous stent grafts may be available in some situations; therefore, it is necessary to consider the surgical strategy including how to manage the stentgraft according to each individual case.

Descending/Thoracoabdominal Aorta