Perioperative differences between endovascular repair of thoracic and abdominal aortic aneurysms

Robert J. Feezor, MD, Thomas S. Huber, MD, Peter R. Nelson, MD, Scott A. Berceli, MD, PhD, James M. Seeger, MD, W. Anthony Lee, MD.
University of Florida, Gainesville, FL, USA.

OBJECTIVES: With the recent FDA-approval of the Gore TAG thoracic device, more thoracic pathologies may be treated using endovascular techniques. Although there are some technical similarities between endovascular abdominal and thoracic aortic repairs, there are substantive differences that can impact perioperative outcomes. The purpose of this study is to highlight these differences.
METHODS: Seventy-three endovascular thoracic aortic repairs and 452 AAA repairs were performed at a single institution over a 4-year period. Data were prospectively collected and retrospectively reviewed.
RESULTS: The mean age of patients undergoing AAA repair was 72.2 +/- 9.0, compared to 70.4 +/- 30.5 for TAA (p=NS). There were more women undergoing TAA repair (88.1% vs. 63.0%, p<0.01). The aneurysm diameters were similar for each group (58.3 mm for AAA vs. 59.8 mm for TAA, p=NS). Intraoperatively, AAA repairs required 25.7 minutes of fluoroscopy compared to 20.2 minutes for thoracic repairs (p<0.01). The amount of contrast used was higher in TAA repairs (133.5 mL vs. 90.8 mL, p<0.001). The mean time for AAA repair was 167 minutes while the mean procedure time for TAA repair was 122 minutes. Iliac conduits or iliofemoral bypasses were required in 35 (7.7%) patients undergoing AAA repairs while 18 (25%) were required in those undergoing thoracic repairs (p<0.001). 30-day or in-hospital mortality was 2.0% for AAA and 1.4% for thoracic repairs (p=NS). The length of stay was longer for TAA (6.1 vs. 3.3 days). There were 40 (54.8%) postoperative complications among the thoracic patients. They included 4 strokes, 14 transient spinal cord ischemias, 6 renal insufficiencies, and 6 pulmonary complications. Among the AAA repairs, there were 16 (36.3%) postoperative complications involving 38 (8.4%) ischemic, 33 (7.3%) wound-related, 10 (2.2%) neurologic, 18 renal (4.0%), and 8 (1.8%) pulmonary events.
CONCLUSIONS: There is higher incidence of women undergoing endovascular thoracic aortic repairs than abdominal repairs and this is reflected in a greater need for iliac access to accommodate larger delivery catheters. Intraoperative imaging techniques are also different and the procedure requires higher contrast volumes, which may result in greater incidence of renal complications. There is also a higher incidence of neurologic complications during thoracic aortic repairs involving strokes and spinal cord ischemia that may be related to the proximity of the disease to the great vessels and the extent of the aorta that is covered.

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