Outcome following open TAAA repair after TEVAR compared to conventional open type II TAAA repair

VASA, vol. 55, pp. 114–120

Abstract

Summary: Background: Open thoracoabdominal aortic aneurysm (TAAA) repair for Crawford extent II aneurysms carries substantial risks. This study compares outcomes of open TAAA repair following prior thoracic endovascular aortic repair (TEVAR) with conventional open extent II repair. Patients and methods: A retrospective analysis of 91 patients (2006–2024) divided into prior TEVAR (n=29) and conventional repair Crawford extent II repair without previous TEVAR (n=62). Primary endpoints included mortality and complications; secondary endpoints assessed survival and reinterventions. This study was designed according to STROBE criteria. Results: The prior TEVAR group (n=29) had a mean age of 61.5±10.7 years and 72.4% were male, while the conventional extent II repair group (n=62) had a mean age of 63.2±9.8 years and 69.4% were male. Prior TEVAR patients underwent open repair for extent II (13.8%), III (58.6%), or IV (27.6%) aneurysms. In-hospital mortality was lower in the prior TEVAR group (6.9% vs. 25.8%, p =.07), as were rates of spinal cord ischemia (3.4% vs. 8.1%, p =.55), acute kidney injury (24.1% vs. 35.5%, p =.28), and massive transfusion (24.1% vs. 30.6%, p =.54). Pulmonary complications occurred less frequently after TEVAR (69.0% vs. 82.3%, p =.25). Kaplan-Meier analysis revealed no significant survival difference (log-rank p=.05), with 5-year survival rates of 94% (prior TEVAR) and 61% (conventional). Aortic reintervention rates were also similar (10.5% vs. 18.8%, p=.69). Conclusions: Open TAAA repair following prior TEVAR may offer clinically meaningful advantages over conventional open type II repair with acceptable survival rates; however, these findings should be interpreted cautiously given the study’s retrospective design and small sample size. Staged hybrid approach could be a viable strategy for managing complex aortic pathologies.

Authors 7

1. Jelle Frankort Aachen Vascular Surgery Department

   Universitätsklinikum Aachen · Maastricht University Medical Centre

   Affiliation as printed

   Department of Vascular Surgery, Maastricht University Medical Centre (MUMC), The Netherlands

   Vascular Surgery Department, University Hospital Aachen, Germany

2. András Keszei Aachen Centre for Translational & Clinical Research Aachen (CTC-A)

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Centre for Translational & Clinical Research Aachen (CTC-A), University Hospital RWTH Aachen, Germany

3. Christian Uhl Aachen Vascular Surgery Department

   Universitätsklinikum Aachen

   Affiliation as printed

   Vascular Surgery Department, University Hospital Aachen, Germany

4. Michael J.H.M. Jacobs Aachen Vascular Surgery Department

   Universitätsklinikum Aachen · Maastricht University Medical Centre

   Affiliation as printed

   Department of Vascular Surgery, Maastricht University Medical Centre (MUMC), The Netherlands

   Vascular Surgery Department, University Hospital Aachen, Germany

   Vascular Surgery Department, University Hospital Aachen, Germany Department of Vascular Surgery, Maastricht University Medical Centre (MUMC), The Netherlands

5. Barend M.E. Mees

   Maastricht University Medical Centre

   Affiliation as printed

   Department of Vascular Surgery, Maastricht University Medical Centre (MUMC), The Netherlands

6. Alexander Gombert Aachen Vascular Surgery Department

   Universitätsklinikum Aachen

   Affiliation as printed

   Vascular Surgery Department, University Hospital Aachen, Germany

7. Moustafa Elfeky Aachen Vascular Surgery Department

   Universitätsklinikum Aachen

   Affiliation as printed

   Vascular Surgery Department, University Hospital Aachen, Germany