Open Surgery versus Endovascular Surgery in the Treatment of the Descendent Thoracic Aortic Disease
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Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has increased worldwide more than open repair in the last few years.
Objective: To compare clinical outcomes of TEVAR versus open surgery at Fundación Cardio Infantil (Bogota, Colombia), between 2002 and 2011.
Methods: Retrospective analysis of the cohort of patients with open repair (group 1) in comparison to TEVAR (group 2). In each group, surgical time, morbidity rates (infection, hemorrhage, medular ischemia, cerebrovascular event, and postoperative renal failure), mortality, reintervention, and hospital stay were evaluated. For comparisons a univariate analysis was used, being a p
< 0.05 statistically significant.
Results: 57 patients were included (26 % open repair; 74 % TEVAR). Two type 1 endoleaks on group 2 and 1 bleeding patient in group 1 required a second surgery. Surgical mortality was 20 % in group 1, and 2.3 % in group 2); surgical time was 398 ± 180 (group 1) versus 85.5 ± 35 min (group 2) (p = 0.0001); and hospital stay was 9,8 days (group 1) and 5.3 days (group 2). Average follow-up time was 4.8 ± 3.1 years.
Conclusions: TEVAR may be associated with less morbidity, mortality, surgical time, and hospital stay than open repair, although the populations included were not strictly comparable. New, prospective studies, ideally randomized,
are needed to support the long term benefits of this type of repair.
aorta torácica, aorta descendente, enfermedades de la aorta, aneurisma de la aorta, procedimientos endovasculares, Thoracic aorta, descending aorta, aortic disease, thoracic aortic aneurysm, endovascular techniques,
2. Knepper J, Upchurch G. A review of clinical trials and registries in descending thoracic aortic aneurysms. Semin Vasc Surg. 2010;23:170-5.
3. Estrera A, Miller C, Chen E, Meada R, Torres R, Porat E et al. Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage. Ann Thorac Surg. 2005;80:1290-6.
4. Stone D, Brewster D, Kwolek C, LaMuraglia G, Conrad M, Chung T, et al. Stent-graft versus open-surgical repair of the thoracic aorta: Mid-term results. J Vasc Surg. 2006;44:1188-97.
5. Jonker F, Giacovelli J, Muhs B, Sosa J, Indes J. Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury. J Vasc Surg. 2010;51:565-71.
6. Bavaria J, Coselli J, Curi M, Eggebrecht H, Elefteriades J, Erbel R, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008;85:S1-S41.
7. Rousseau H, Chabbert V, Maracher M, El Aassar O, Auriol J, Massabuau P, et al. The importance of imaging assessment before endovascular repair. Eur J Vasc Endovasc Surg. 2009;38:408-21.
8. Coady M, Ikonomidis J, Cheung A, Matsumoto A, Dake M, Chaikof E, et al. Surgical management of descending thoracic aortic disease: open and endovascular approaches: a scientific statement from the American Heart Association. Circulation. 2010;121:2780-2804.
9. Cheng D, Martin J, Shennib H, Dunning J, Muneretto C, Schueler S, Von Segesser L, et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease: a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol. 2010;55:986-1001.
10. Dake M, Miller D, Semba C, Mitchell R, Walker P, Liddell R. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331:1729-34.
11. Scali S, Goodney P, Walsh D, Travis L, Nolan B, Goodman D, et al. National trend and regional variation of open and endovascular repair of thoracic and thoraco abdominal aneurysms in contemporary practice. J Vasc Surg. 2011;53:1499-505.
12. Walker K, Shuster J, Martin T, Hess P, Klodell C, Feezor R, et al. Practice patterns for thoracic aneurysms in the stent graft era: health care system implications. Ann Surg. 2010;252:603-10.
13. Conrad M, Ergul E, Patel V, Paruchuri V, Kwolek C, Cambria R. Management of disease of the descending thoracic aorta in the endovascular era: a Medicare population study. Ann Surg. 2010;252:603-10.
14. Greenberg R, Lu Q, Roselli E, Svensson L, Moon M, Hernández A, et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation. 2008;118: 808-17.
15. Jonker K, Verhagen H, Lin P, Heijmen R, Trimarchi S, Lee W, et al. Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. J Vasc Surg. 2011;53:1210-6.
16. Jonker F, Trimarchi S, Verhagen H, Moll F, Sumpio B, Muhs B. Meta-analysis of open versus endovascular repair for ruptured descending thoracic aortic aneurysm. J Vasc Surg. 2010;51:1026-32.
17. Nienaber C, Kische S, Ince H, Fattori R. Thoracic endovascular aneurysm repair for complicated type B aortic dissection. J Vasc Surg. 2011;54:1529-33.
18. Nathan D, Boonn W, Lai E, Wang G, Desai N, Woo E, et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg. 2012;55:10-5.
19. Thrumurthy S, Karthikesalingam A, Patterson B, Holt P, Hinchliffe R, Loftus I, et al. A Systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg. 2011;42:632-47.
20. Arnaoutakis G, Hundt J, Shah A, Cameron D, Black J. Comparative analysis of hospital costs of open and endovascular thoracic aortic repair. Vasc Endovascular Surg. 2011;45:39-45.