Complete renovisceral debranching and EVAR for thoracoabdominal aneurysm

Abstract

Open graft repair of thoracoabdominal aortic aneurysms (TAAA) is an incredibly complex and challenging procedure with acceptable results achieved only by a few centers worldwide. Contemporary outcome analysis of TAAA repair performed in the United States showed greater operative mortality and morbidity rates than commonly reported. Moreover, a recent European long-term follow-up study showed that survival remains suboptimal, especially in the early years after TAAA repair. Complete renovisceral debranching combined with EVAR offers many advantages in regard to open surgical repair with comparable or better results, especially in the high-risk patient. Although this hybrid procedure will not replace open surgical repair, the latter will significantly decrease during the next decades, as very experienced surgeons will be lacking, due to the mainly endovascular generation of surgeons being educated nowadays. Similarly, the results of the hybrid TAAA repair will improve, as new techniques will eliminate most barriers still existing today.