Published Online
on August 4, 2008

A more recent version of this article appeared on August 19, 2008

This Article Full Text (PDF) CME: Take the course for this article: Circulation: August 19, 2008, Volume 118, Number 8 All Versions of this Article: 118/8/808    most recent CIRCULATIONAHA.108.769695v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Greenberg, R. K. Articles by Lytle, B. W. Search for Related Content PubMed PubMed Citation Articles by Greenberg, R. K. Articles by Lytle, B. W. Pubmed/NCBI databases Medline Plus Health Information Aortic Aneurysm Related Collections CV surgery: aortic and vascular disease Related Article

Submitted on February 1, 2008
Accepted on June 10, 2008

Contemporary Analysis of Descending Thoracic and Thoracoabdominal Aneurysm Repair. A Comparison of Endovascular and Open Techniques

Roy K. Greenberg MD^*, Qingsheng Lu MD, Eric E. Roselli MD, Lars G. Svensson MD, PhD, Michael C. Moon MD, Adrian V. Hernandez MD, MSc, PhD, Joseph Dowdall MD, Marcelo Cury MD, Catherine Francis BS, Kathryn Pfaff BS, Daniel G. Clair MD, Kenneth Ouriel MD, and Bruce W. Lytle MD

From The Cleveland Clinic Foundation, Cleveland, Ohio.

^* To whom correspondence should be addressed. E-mail: greenbr{at}ccf.org.

Background—Endovascular repair of thoracic aneurysm has demonstrated low risks of mortality and spinal cord ischemia (SCI), but few large series have been published on endovascular thoracoabdominal aneurysm repair, and reports suffer from a lack of accurate comparison with similar open surgical procedures.

Methods and Results—A consecutive cohort of patients with thoracic and thoracoabdominal aneurysms treated electively with endovascular repair (ER) or surgical repair (SR) techniques between 2001 and 2006 were analyzed. The association between repair technique and SCI was evaluated with univariable analysis. Adjustments for potential confounders and for the propensity to receive ER or SR were also performed in multivariable analysis. A total of 724 patients (352 ER, 372 SR) underwent repair. The mean age was 67 years, and 65% were male. ER patients were on average 9 years older (P<0.001), had more comorbid conditions, and more frequently had prior distal repair (P<0.001) or underwent a type I or IV repair. SR patients more commonly had chronic dissection or required type II or type III repairs (P<0.001). Mortality at 30 days (5.7% ER versus 8.3% SR, P=0.2) and 12 months (15.6% ER versus 15.9% SR, P=0.9) was similar. A borderline difference in SCI was found between repair techniques: 4.3% of ER and 7.5% of SR patients (P=0.08) had SCI. In patients with ER, prior distal aortic operation was associated with the development of SCI in univariable analysis (odds ratio 4.1, 95% confidence interval 1.4 to 11.7). Multivariable analysis showed that the type of required repair (type I, II, III, or IV) was the primary factor associated with the development of SCI in ER and SR patients.

Conclusion—No significant difference in the incidence of mortality or SCI was found between ER and SR techniques. The strongest factor associated with SCI remains the extent of the disease. Further studies are indicated to compare ER with patients considered eligible for SR.

Key words: spinal cord ischemia • stents • aorta • aneurysm • aneurysm, dissecting

Related Article:

Circulation: Clinical Summaries
Circulation 2008 118: 793-794. [Extract] [Full Text]

This article has been cited by other articles:

				B. Modarai, R. Bell, and P. Taylor Letter by Modarai et al Regarding Article, "Contemporary Analysis of Descending Thoracic and Thoracoabdominal Aneurysm Repair" Circulation, September 15, 2009; 120(11): e89 - e89. [Full Text] [PDF]

				N. Shiiya, S. Wakasa, K. Matsui, T. Sugiki, Y. Shingu, T. Yamakawa, and Y. Matsui Anatomical pattern of feeding artery and mechanism of intraoperative spinal cord ischemia. Ann. Thorac. Surg., September 1, 2009; 88(3): 768 - 771. [Abstract] [Full Text] [PDF]

				D. H. Adams, A. C. Anyanwu, J. Chikwe, and F. Filsoufi The Year in Cardiovascular Surgery J. Am. Coll. Cardiol., June 23, 2009; 53(25): 2389 - 2403. [Full Text] [PDF]

				H. Eggebrecht, R. H. Mehta, A. Dechene, K. Tsagakis, H. Kuhl, S. Huptas, G. Gerken, H. G. Jakob, and R. Erbel Aortoesophageal Fistula After Thoracic Aortic Stent-Graft Placement: A Rare but Catastrophic Complication of a Novel Emerging Technique J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 570 - 576. [Abstract] [Full Text] [PDF]

				L. Svensson Aortic dissection endovascular stenting: less pain, survival gain? Ann. Thorac. Surg., May 1, 2009; 87(5): 1332 - 1333. [Full Text] [PDF]

				C. A. Nienaber, I. Akin, R. Erbel, and A. Haverich CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]