Current state of endovascular repair of thoracoabdominal aortic aneurysms

Abstract

Thoracoabdominal aortic aneurysm (TAAA) is a severe and complex condition with multifactorial etiology that can lead to life-threatening complications. Its treatment is genuinely complex irrespective of the chosen technique, open or endovascular repair. Fenestrated-branched endovascular aneurysm repair (F/B-EVAR) has been increasingly accepted in patients with suitable anatomy, resulting in outcomes compared to or superior to open repair. The selection of patients, judicious surgical planning, and device selection are paramount to achieving successful treatment. The field of TAAA repair is continuously evolving with ongoing research and the development of new techniques and devices to further improve patient outcomes. This paper aims to present a review of endovascular TAAA treatment, summarizing anatomical and clinical features relevant to technical performance and treatment indications.

Keywords

F/B-EVAR / TAAA / thoracoabdominal aortic aneurysm / aneurysm / endovascular

References

[1] Nation DA.TEVAR: endovascular repair of the thoracic aorta.Semin Intervent Rad2015;32:265-71 PMCID:PMC4540616

[2] Chait J,DeMartino RR.Anatomic factors to guide patient selection for fenestrated-branched endovascular aortic repair.Semin Vasc Surg2022;35:259-79

[3] Paajanen P,Tenorio ER,Oderich GS.Effect of patient frailty status on outcomes of fenestrated-branched endovascular aortic repair for complex abdominal and thoracoabdominal aortic aneurysms.J Vasc Surg2022;76:1170-9.e2

[4] De Bakey ME, Cooley DA. Successful resection of aneurysm of thoracic aorta and replacement by graft.J Am Med Assoc1953;152:673-6

[5] Crawford ES.Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries.Ann Surg1974;179:763-72 PMCID:PMC1356071

[6] Crawford ES,Safi HJ.Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients.J Vasc Surg1986;3:389-404

[7] Dake MD,Semba CP,Walker PJ.Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms.N Engl J Med1994;331:1729-34

[8] Dake MD,Mitchell RS.Endovascular stent-graft placement for the treatment of acute aortic dissection.N Engl J Med1999;340:1546-52

[9] Nienaber CA,Lund G.Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.N Engl J Med1999;340:1539-45

[10] Makaroun MS,Kee ST.Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis.J Vasc Surg2005;41:1-9

[11] Chuter TA,Reilly LM,Messina LM.An endovascular system for thoracoabdominal aortic aneurysm repair.J Endovasc Ther2001;8:25-33

[12] Riesenman PJ,Kasirajan K.Endovascular management of a ruptured thoracoabdominal aneurysm-damage control with superior mesenteric artery snorkel and thoracic stent-graft exclusion.Ann Vasc Surg2011;25:555.e5-9

[13] Marchal J,Astarci P.Endovascular repair of a ruptured thoracoabdominal aortic aneurysm with the sandwich technique: a case report.Vasc Endovascular Surg2021;55:86-90

[14] Benjelloun A,Ghannam A.Endovascular treatment of a tuberculous thoracoabdominal aneurysm with the multilayer stent.J Endovasc Ther2012;19:115-20

[15] Moulakakis KG,Antonopoulos CN.Open repair of thoracoabdominal aortic aneurysms in experienced centers.J Vasc Surg2018;68:634-45.e12

[16] Cowan JA Jr,Henke PK,Stanley JC.Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes.J Vasc Surg2003;37:1169-74

[17] Cambria RP,Davison JK,Corey M.Thoracoabdominal aneurysm repair: results with 337 operations performed over a 15-year interval.Ann Surg2002;236:471-9 PMCID:PMC1422602

[18] Svensson LG,Hess KR,Safi HJ.Experience with 1509 patients undergoing thoracoabdominal aortic operations.J Vasc Surg1993;17:357-68

[19] Coselli JS,Preventza O.Outcomes of 3309 thoracoabdominal aortic aneurysm repairs.J Thorac Cardiovasc Surg2016;151:1323-37

[20] Greenberg RK,Roselli EE.Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques.Circulation2008;118:808-17

[21] Zafar MA,Wu J.Yale Aortic Institute Natural History InvestigatorsNatural history of descending thoracic and thoracoabdominal aortic aneurysms.J Thorac Cardiovasc Surg2021;161:498-511.e1

[22] Isselbacher EM,Hamilton Black J 3rd.2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American heart association/American college of cardiology joint committee on clinical practice guidelines.Circulation2022;146:e334-482

[23] Verhoeven EL,Oikonomou K.Fenestrated and branched stent-grafts to treat post-dissection chronic aortic aneurysms after initial treatment in the acute setting.J Endovasc Ther2012;19:343-9

[24] Ziganshin BA.Surgical management of thoracoabdominal aneurysms.Heart2014;100:1577-82

[25] Elefteriades JA.Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks.Ann Thorac Surg2002;74:S1877-80

[26] Svensson LG,Miller DC.Society of Thoracic Surgeons Endovascular Surgery Task ForceExpert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg2008;85:S1-41

[27] Hiratzka LF,Beckman JA.2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American college of cardiology foundation/American heart association task force on practice guidelines, American association for thoracic surgery, American college of radiology, American stroke association, society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, society of interventional radiology, society of thoracic surgeons, and society for vascular medicine.Circulation2010;121:e266-369

[28] Ouzounian M,Svensson LG,Oderich GS.Thoracoabdominal aortic disease and repair: JACC focus seminar, part 3.J Am Coll Cardiol2022;80:845-56

[29] Rocha RV,Elbatarny M.A systematic review and meta-analysis of early outcomes after endovascular versus open repair of thoracoabdominal aortic aneurysms.J Vasc Surg2018;68:1936-45.e5

[30] Bertoglio L,Ferrer C.Comparison of sacrificed healthy aorta during thoracoabdominal aortic aneurysm repair using off-the-shelf endovascular branched devices and open surgery.J Vasc Surg2018;67:695-702

[31] Spanos K,Detter NC.Endovascular treatment of aortic aneurysms and dissections in patients with genetically triggered aortic diseases.Semin Vasc Surg2022;35:320-33

[32] Oderich GS,Sandri GA.Evolution from physician-modified to company-manufactured fenestrated-branched endografts to treat pararenal and thoracoabdominal aortic aneurysms.J Vasc Surg2019;70:31-42.e7

[33] Oderich GS,Farber M.Zenith Fenestrated Study InvestigatorsResults of the United States multicenter prospective study evaluating the zenith fenestrated endovascular graft for treatment of juxtarenal abdominal aortic aneurysms.J Vasc Surg2014;60:1420-8.e1

[34] Pyun AJ.Contemporary indications, techniques, and outcomes of physician-modified endografts for the treatment of complex abdominal and thoracoabdominal aortic aneurysms.Semin Vasc Surg2022;35:364-73

[35] Oderich GS,Hofer J.Prospective, nonrandomized study to evaluate endovascular repair of pararenal and thoracoabdominal aortic aneurysms using fenestrated-branched endografts based on supraceliac sealing zones.J Vasc Surg2017;65:1249-59.e10

[36] Oderich GS,Silveira PG.Technical aspects and 30-day outcomes of the prospective early feasibility study of the GORE EXCLUDER thoracoabdominal branched endoprosthesis (TAMBE) to treat pararenal and extent IV thoracoabdominal aortic aneurysms.J Vasc Surg2019;70:358-68.e6

[37] Atkins AD.Branched and fenestrated aortic endovascular grafts.Methodist Debakey Cardiovasc J2023;19:15-23

[38] Kölbel T,Jama K.Early outcomes of the t-branch off-the-shelf multi-branched stent graft in 542 patients for elective and urgent aortic pathologies: a retrospective observational study.J Vasc Surg2021;74:1817-24

[39] Zettervall SL.Planning and sizing of fenestrated/branched stent grafts.Semin Vasc Surg2022;35:252-8

[40] Chait J,Mendes BC.Impact of gap distance between fenestration and aortic wall on target artery instability following fenestrated-branched endovascular aortic repair.J Vasc Surg2022;76:79-87.e4

[41] Katsargyris A,Verhoeven EL.Graft design and selection of fenestrations vs. branches for renal and mesenteric incorporation in endovascular treatment of pararenal and thoracoabdominal aortic aneurysms.J Cardiovasc Surg2019;60:35-40

[42] Mendes BC,Reis de Souza L.Implications of renal artery anatomy for endovascular repair using fenestrated, branched, or parallel stent graft techniques.J Vasc Surg2016;63:1163-9.e1

[43] Martin-Gonzalez T,Carrell T.Mid-term outcomes of renal branches versus renal fenestrations for thoraco-abdominal aneurysm repair.Eur J Vasc Endovasc Surg2016;52:141-8

[44] Sugimoto M,Bisdas T,Torsello G.Tortuosity is the significant predictive factor for renal branch occlusion after branched endovascular aortic aneurysm repair.Eur J Vasc Endovasc Surg2016;51:350-7

[45] Tenorio ER,Mendes BC.Outcomes of directional branches using self-expandable or balloon-expandable stent grafts during endovascular repair of thoracoabdominal aortic aneurysms.J Vasc Surg2020;71:1489-502.e6

[46] Tenorio ER,Timaran CH.US. Fenestrated and Branched Aortic Research Consortium. Mid-term renal and mesenteric artery outcomes during fenestrated and branched endovascular aortic repair for complex abdominal and thoracoabdominal aortic aneurysms in the united states aortic research consortium.Ann Surg2023;278:e893-902

[47] Kim S,Farber MA.Choice of optimal bridging stent and methods of visceral vessel incorporation during fenestrated/branched endovascular aortic repair for thoracoabdominal and complex abdominal aortic aneurysms.Semin Vasc Surg2022;35:280-6

[48] Tenorio ER,Timaran CH.US. Fenestrated and Branched Aortic Research Consortium. Effect of bridging stent graft selection for directional branches on target artery outcomes of fenestrated-branched endovascular aortic repair in the United States Aortic Research Consortium.J Vasc Surg2023;78:10-28.e3

[49] Lima GBB,Tenorio ER,Oderich GS.Endovascular repair of complex aortic aneurysms.Adv Surg2022;56:305-19

[50] Porras-Colon J,Timaran CH.Outcomes and strategies for utilization of brachial access and preloaded systems during F/BEVAR.Semin Vasc Surg2022;35:287-96

[51] Bertoglio L,Cambiaghi T,Melissano G.Percutaneous axillary artery access for fenestrated and branched thoracoabdominal endovascular repair.J Vasc Surg2018;68:12-23

[52] Agrusa CJ,Ellozy SH.Safety and effectiveness of percutaneous axillary artery access for complex aortic interventions.Ann Vasc Surg2019;61:326-33

[53] Al Adas Z,Mazur A.Safety and learning curve of percutaneous axillary artery access for complex endovascular aortic procedures.J Vasc Surg2024;79:487-96

[54] Chamseddin KH,Scott CK.Outcomes of upper extremity versus transfemoral access for fenestrated-branched endovascular aortic repair.J Vasc Surg2022;75:e41

[55] Mirza AK,Marcondes GB.Comparison of cerebral embolic events between right and left upper extremity access during fenestrated/branched endovascular aortic repair.J Endovasc Ther2021;28:70-7

[56] Motyl CM.Strategies for prevention and treatment of spinal cord ischemia during F/BEVAR.Semin Vasc Surg2022;35:297-305

[57] Aucoin VJ,Novak Z.Trends in the use of cerebrospinal drains and outcomes related to spinal cord ischemia after thoracic endovascular aortic repair and complex endovascular aortic repair in the vascular quality initiative database.J Vasc Surg2021;74:1067-78

[58] Griepp RB.Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept.Ann Thorac Surg2007;83:S865-9

[59] Rocha RV,Friedrich JO.Systematic review of contemporary outcomes of endovascular and open thoracoabdominal aortic aneurysm repair.J Vasc Surg2020;71:1396-412.e12

[60] Rocha RV,Austin PC.Outcomes after endovascular versus open thoracoabdominal aortic aneurysm repair: a population-based study.J Thorac Cardiovasc Surg2021;161:516-27.e6

[61] Motta F,Kalbaugh CA.Outcomes and complications after fenestrated-branched endovascular aortic repair.J Vasc Surg2019;70:15-22

[62] Oderich GS,Mendes BC.Midterm outcomes of a prospective, nonrandomized study to evaluate endovascular repair of complex aortic aneurysms using fenestrated-branched endografts.Ann Surg2021;274:491-9

[63] Oikonomou K,Katsargyris A,Pfister K.Mid-term results of fenestrated/branched stent grafting to treat post-dissection thoraco-abdominal aneurysms.Eur J Vasc Endovasc Surg2019;57:102-9

[64] Law Y,Rohlffs F.Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm.J Vasc Surg2019;70:404-12

[65] Zettervall SL,Schanzer A.U.S. Fenestrated and Branched Aortic Research Consortium. Secondary interventions after fenestrated/branched aneurysm repairs are common and nondetrimental to long-term survival.J Vasc Surg2022;75:1530-8.e4

[66] Chait J,Hofer JM,Oderich GS.Five-year outcomes of physician-modified endografts for repair of complex abdominal and thoracoabdominal aortic aneurysms.J Vasc Surg2023;77:374-85.e4