December 12, 2008

Early and Late outcomes of open thoracoabdominal aortic aneurysm repair in patients younger than 50 years

Nanette R. Reed, MD, Manju Kalra, MBBS, Cornelius Groenewald, MBChB, Thoralf Sundt, III, MD, Thomas Bower, MD, Audra Duncan, MD, Gustavo Oderich, MD, Joseph Ricotta, MD, Peter Gloviczki, MD.
Mayo Clinic-Rochester, MN, Rochester, MN, USA.

Objectives: Descending thoracic (TAA) and thoracoabdominal aortic aneurysms (TAAA) in patients <50 years are rare and often represent a manifestation of connective tissue disorders (CTD). The aim of this study was to evaluate outcomes of elective open TAA/TAAA repair in young patients to serve as a basis for comparison for potential future endovascular procedures.
Methods: Data from 527 consecutive patients who underwent elective TAA/TAAA repair from 1971 to 2007 were analyzed retrospectively. Forty-eight patients <50 years were identified. Patients with acute dissection were excluded.
Results: There were 32 males and 16 females (median age 40 years; range 18 -50) with 30 TAA, 2 Crawford Type I, 5 Type II, 10 Type III, and 1 Type IV TAAAs. Seventeen (37%) aneurysms were secondary to CTDs: Marfan’s (n=9), Ehlers-Danlos (n=2), Takayasu’s arteritis (n=3), Behcet’s (n=1), and Tuberous sclerosis (n=2); the remainder were atherosclerotic/degenerative (n=17), post-traumatic (n=12), or post-congenital coarctation repair (n=2). Two patients were pregnant at presentation. Mean aneurysm diameter was 6.5 cm. All patients underwent standard open surgical repair through a left thoracic/thoracoabdominal approach. There were no early post-operative deaths. Major complications developed in 13/48 (27%), including cardiac (n=3), renal (n=4), paraplegia/paraparesis (n=3), chylothorax (n=1), and cerebral ischemia (n=2). Median hospital length of stay was 8.5 days (range 6-44). Mean follow-up was 33 months (range 1-372 months). Twelve patients (25%) had prior aortic surgery. Fifteen (31%) patients required aortic re-intervention; paravisceral patch aneurysm repair (n=3), ascending or aortic arch repair (n=8) associated with 20% (3/15) mortality. On univariate analysis, the incidence of re-intervention was not significantly higher in patients with CTD. One, 5 and 10 year cumulative survival survival rates were 98%, 94% and 82% respectively.
Conclusion: Open TAAA repair in young patients is associated with favorable early and long-term outcome. Late occurrence of paravisceral patch aneurysms may contraindicate use of the visceral patch technique. A significant proportion of patients require further aortic intervention and long-term imaging surveillance is advised.

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