Open surgery remains the gold standard for the repair of thoraco-abdominal aortic aneurysms (TAAAs), although it is complicated by high rates of morbidity and mortality, especially in urgent /emergent settings. In this regard, the technique of parallel stent grafts has proved to be a valid alternative that can be performed in urgency compared to off-the-shelf fenestrated or branched endografts (whose use is still debated in cases of complex aortic anatomy) and custom-made fenestrated or branched endografts (hardly available in urgency due to the long time required for their realization), although some concerns still remain regarding its duration and its complications in the treatment of TAAAs. The purpose of this study is to analyze the short and mid-term results of a series of 20 patients with complex aortic aneurysms treated with parallel stent techniques, in an urgency and emergency setting, in the period 2016-2019 at the Unit of Vascular Surgery of the IRCCS Policlinico San Matteo. All cases were retrospectively reviewed, reporting the operative technique employed, primary technical success and long-term outcomes. Each patient underwent follow-up with CT angiography three months after the procedure and annually thereafter (median follow-up of 22 months). Technical success, assessed at completion angiography, was achieved in all cases (100%), all-cause mortality was 10%, while the stent patency rate was 100% and remained stable throughout the follow-up. During this period, three cases of endoleak were observed (one type IB and two type II): all complications were managed conservatively, except for the first case, which was re-treated endovascularly (reoperation rate of 5 %). In the light of these findings, parallel stents have proven to be a safe and feasible treatment for TAAAs in urgent and emergent settings.
La chirurgia open rimane il gold standard per la riparazione degli aneurismi dell’aorta toraco-addominale (TAAAs), sebbene sia complicata da alti tassi di morbidità e mortalità, specialmente in situazioni di urgenza/emergenza. A tal proposito, la tecnica degli innesti a stent paralleli si è dimostrata una valida alternativa che può essere eseguita in urgenza rispetto alle endoprotesi fenestrate o ramificate off-the-shelf (il cui impiego è ancora dibattuto nei casi di anatomia aortica complessa) e custom-made (difficilmente reperibili in urgenza a causa del lungo tempo necessario alla loro realizzazione), sebbene permangano ancora alcune preoccupazioni relative alla sua durata e alle sue complicanze nel trattamento dei TAAAs. Lo scopo di questo studio è quello di analizzare i risultati a breve e medio termine di una casistica di 20 pazienti con aneurismi aortici complessi trattati con le tecniche a stent paralleli, in un setting di urgenza ed emergenza, nel periodo 2016-2019 presso l’Unità Operativa di Chirurgia Vascolare dell’IRCCS Policlinico San Matteo. Tutti i casi sono stati rivisti retrospettivamente, riportando la tecnica operativa impiegata, il successo tecnico primario e gli esiti a lungo termine. Ogni paziente è stato sottoposto a follow-up con angio-TC a tre mesi dalla procedura e successivamente ogni anno (follow-up mediano di 22 mesi). Il successo tecnico, valutato all’angiografia di completamento, è stato ottenuto in tutti i casi (100%), la mortalità per tutte le cause è stata del 10%, mentre il tasso di pervietà degli stent è stato del 100% ed è rimasto stabile per tutto il follow-up. Durante questo periodo, sono stati osservati tre casi di endoleak (uno di tipo IB e due di tipo II): tutte le complicanze sono state gestite in modo conservativo, ad eccezione del primo caso, nuovamente trattato in modo endovascolare (tasso di reintervento del 5%). Alla luce di questi risultati, gli stent paralleli si sono confermati un trattamento sicuro ed efficace per i TAAAs in contesti urgenti ed emergenti.
RISULTATI A BREVE E MEDIO TERMINE DELLA TECNICA A STENT PARALLELI NEL TRATTAMENTO ENDOVASCOLARE DEGLI ANEURISMI DELL’AORTA TORACO-ADDOMINALE IN URGENZA
FRIGERIO, GIAN MARCO
2020/2021
Abstract
Open surgery remains the gold standard for the repair of thoraco-abdominal aortic aneurysms (TAAAs), although it is complicated by high rates of morbidity and mortality, especially in urgent /emergent settings. In this regard, the technique of parallel stent grafts has proved to be a valid alternative that can be performed in urgency compared to off-the-shelf fenestrated or branched endografts (whose use is still debated in cases of complex aortic anatomy) and custom-made fenestrated or branched endografts (hardly available in urgency due to the long time required for their realization), although some concerns still remain regarding its duration and its complications in the treatment of TAAAs. The purpose of this study is to analyze the short and mid-term results of a series of 20 patients with complex aortic aneurysms treated with parallel stent techniques, in an urgency and emergency setting, in the period 2016-2019 at the Unit of Vascular Surgery of the IRCCS Policlinico San Matteo. All cases were retrospectively reviewed, reporting the operative technique employed, primary technical success and long-term outcomes. Each patient underwent follow-up with CT angiography three months after the procedure and annually thereafter (median follow-up of 22 months). Technical success, assessed at completion angiography, was achieved in all cases (100%), all-cause mortality was 10%, while the stent patency rate was 100% and remained stable throughout the follow-up. During this period, three cases of endoleak were observed (one type IB and two type II): all complications were managed conservatively, except for the first case, which was re-treated endovascularly (reoperation rate of 5 %). In the light of these findings, parallel stents have proven to be a safe and feasible treatment for TAAAs in urgent and emergent settings.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/13004