Usefulness of Visceral Debranching and TEVAR Method for High Risk TAAA Patients

Takayuki Uchida

Iizuka hospital, Iizuka, Japan

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–A

Abstract

Objectives

About the indication of endovascular treatment, we usually keep the rule of the Insutruction for use in principle. So we select open surgery for TAAA, because in Japan, we can't use branched stent device yet. But for high risk patient, we select debranch+TEVAr method. This time, we analyze the result of the cases in which we performed visceral debranch+TEVAR operation.

Methods

We started endovascular treatment for Aortic Aneurysm in June, 2006 and experienced 480 cases in total until December, 2016. And we experienced 21 cases of visceral debranch+TEVAR operation in this period. Former six first cases; one staged operation(Group O), and latter 15 cases: two stage operation( first; visceral debrandh. Second TEVAR, Group T). An average of visceral bypass grafts were 3. 4. concomitant procedure; Y graft replacement in 2 cases, Aorto-femoral bypass(with 10mm ringed graft) to make access route for second operation(TEVAR) in 3 cases with stenosis of iliac arteries. And in 13cases, spinal drainage were performed by anestheologist.

Results

Mean operative time;389. 0min(Group O), 480. 1+120. 6min(Group T), Number of bypass grafts;1. 83(Group O), 4. 0(Group T) , Mortality1/20 (Group O,Crawford type II , LC cases due to liver failure, MOF, DIC ) Other twenty cases, extubated in OR, and discharged on foot. Paraplegia(-) Risk factor of operation time extension;dialysis cases, history of abdominal surgery, deviation of rt. Renal artery by aneurysm. ?Late results; four cases died(aggravation of COPD:1, Lung cancer:1,Myocardial infaraction: 1, cerebral hemorrhage:1, no Aortic events, no bypass trouble.

Conclusions

This method is not minimally invasive, but less invasive than traditional open surgey for TAAA. And neurological complication was lower(paraplegia (-)). Off course, branched stent method is less invasive than this method, but for cases with shaggy Aorta(especcilally around visceral branches), or stenotis iliac arteries this metho may be one usefull option even in the future.