Abstract 4530: Fifteen Years Experiences and Treatment Strategy of Endovascular Repair of Aortic Aneurysms
Surgical treatments have recently shifted to minimally-invasive procedures in order to respect patient needs and improve postoperative QOL. As pioneers, we have achieved solid results with endovascular aortic repair with stent-grafts since 1993. Here, we report early and long-term results involving endovascular repair of thoracic and abdominal aneurysms.
[METHOD] We have performed endovascular aortic repair (EVAR) in 983 of 1,543 aortic surgeries since 1993. As a treatment strategy for thoracic aortic diseases, when cardiopulmonary bypass was possible, open stent grafting technique (OSG) was performed; when not possible, debranched thoracic endovascular aortic repair (D-TEVAR) was performed for aortic arch aneurysms. TEVAR was performed for the thoracic descending aorta. Of the 722 cases in which thoracic stent-grafts were used, 372 involved TEVAR, 102 involved D-TEVAR, and 248 involved OSG.
[RESULTS] In 722 cases, we used TAG (Gore) in 112 cases, Talent (Medtronic) in 12 cases, and home-made stent-grafts in 598. The mortality rates were 0.6%, 0%, and 2.9% for TEVAR, D-TEVAR, and OSG, respectively. The incidences of post-operative stroke were 0.3%, 4.1%, and 4.8% respectively. In terms of long-term results, freedom from major aortic events for 3 years/5 years/8 years was 94/91/88% for TEVAR, 92/90/84% for D-TEVAR, and 88/86/81% for OSG. Major aortic events rate of TEVAR and D-TEVAR were significantly lower than that of OSG. As a treatment strategy for abdominal aortic diseases, 157 out of 261 total EVAR cases involved the use of commercially manufactured stent-grafts. The mortality rate was 0.6%, the post-operative stroke incidence was 0.6%, and there were no cases of graft obstruction or collapse. Furthermore, none of the current follow-up cases have required re-intervention.
[CONCLUSIONS] We have had early and long-term good results with endovascular aortic repair. Our findings suggest that while fenestrated and branched stent-grafts hold promise for treating aortic arch diseases, hybrid endovascular repair may become the first choice for treating thoracic aortic aneurysms.