Open v. Endovascular Repair of Descending Thoracic and Thora
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Open repair is the standard of care for patients with descending thoracic and thoracoabdominal aortic aneurysms. Although effective, surgery carries a high risk of morbidity and mortality. Endovascular stent-grafts were introduced to treat these aneurysms in patients considered too high risk for open repair. Early results are promising for the same.

Researchers sought to compare short- and intermediate-term outcomes of open versus endovascular repair for these aneurysms.

1,053 patients underwent open (n=457) or endovascular (n=596) repair of descending thoracic and thoracoabdominal aortic aneurysms at Cleveland Clinic. To balance patient characteristics between these groups, propensity-score matching was performed, yielding 278 well-matched pairs. Endpoints included short- and long-term outcomes.

--In matched patients, compared with endovascular stenting, open repair achieved similar in-hospital mortality and occurrence of paralysis and stroke, despite longer postoperative stay, more dialysis-dependent acute renal failure, and prolonged ventilation.

--Open repair resulted in better 10-year survival than endovascular repair, and aortic reintervention was less frequent.

--Despite a decrease in the first postoperative year, average aneurysm size did not recover to normal range after endovascular stenting.

In summary, open repair of descending thoracic and thoracoabdominal aneurysms can achieve acceptable short-term outcomes with better intermediate-term outcomes than endovascular repair.

The Annals of Thoracic Surgery
Source: https://doi.org/10.1016/j.athoracsur.2021.04.100
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