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Results of the North American Complex Abdominal Aortic Debranching (NACAAD) Registry.
Escobar, Guillermo A; Oderich, Gustavo S; Farber, Mark A; de Souza, Leonardo R; Quinones-Baldrich, William J; Patel, Himanshu J; Eliason, Jonathan L; Upchurch, Gilbert R; H Timaran, Carlos; Black, James H; Ellozy, Sharif H; Woo, Edward Y; Fillinger, Mark F; Singh, Michael J; Lee, Jason T; C Jimenez, Juan; Lall, Purandath; Gloviczki, Peter; Kalra, Manju; Duncan, Audra A; Lyden, Sean P; Tenorio, Emanuel R.
Afiliação
  • Escobar GA; Emory University, Atlanta, GA (G.A.E.).
  • Oderich GS; University of Texas Health Science Center at Houston, Houston, TX (G.S.O., E.R.T.).
  • Farber MA; University of North Carolina Health Care, Chapel Hill, NC (M.A.F.).
  • de Souza LR; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil (L.R.d.S.).
  • Quinones-Baldrich WJ; University of California, Los Angeles, CA (W.J.Q.-B., J.C.J.).
  • Patel HJ; University of Michigan Cardiovascular Center, Ann Arbor, MI (H.J.P., J.L.E.).
  • Eliason JL; University of Michigan Cardiovascular Center, Ann Arbor, MI (H.J.P., J.L.E.).
  • Upchurch GR; University of Florida Health, Gainesville, FL (G.R.U.).
  • H Timaran C; University of Texas Southwestern, Dallas, TX (C.H.T.).
  • Black JH; Johns Hopkins Bayview Medical Center, Baltimore, MD (J.H.B).
  • Ellozy SH; Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY (S.H.E.).
  • Woo EY; MedStar Health, Washington, DC (E.Y.W.).
  • Fillinger MF; Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.F.F.).
  • Singh MJ; University of Pittsburgh Medical Center, Pittsburgh, PA (M.J.S.).
  • Lee JT; Stanford University Medical Center, Stanford, CA (J.T.L.).
  • C Jimenez J; University of California, Los Angeles, CA (W.J.Q.-B., J.C.J.).
  • Lall P; Cleveland Clinic Martin Health, Port St. Lucie, FL (P.L., M.K.).
  • Gloviczki P; Mayo Clinic, Rochester, MN (P.G., M.K.).
  • Kalra M; Cleveland Clinic Martin Health, Port St. Lucie, FL (P.L., M.K.).
  • Duncan AA; Mayo Clinic, Rochester, MN (P.G., M.K.).
  • Lyden SP; Schulich School of Medicine and Dentistry, Western University, London, Ontario; Canada (A.A.D.).
  • Tenorio ER; Cleveland Clinic Foundation, Cleveland, OH (S.P.L.).
Circulation ; 146(15): 1149-1158, 2022 10 11.
Article em En | MEDLINE | ID: mdl-36148651
BACKGROUND: Hybrid debranching repair of pararenal and thoracoabdominal aortic aneurysms was initially designed as a better alternative to standard open repair, addressing the limitations of endovascular repair involving the visceral aorta. We reviewed the collective outcomes of hybrid debranching repairs using extra-anatomic, open surgical debranching of the renal-mesenteric arteries, followed by endovascular aortic stenting. METHODS: Data from patients who underwent hybrid repair in 14 North American institutions during 10 years were retrospectively reviewed. Society of Vascular Surgery scores were used to assess comorbidity risk. Early and late outcomes, including mortality, morbidity, reintervention, and patency were analyzed. RESULTS: A total of 208 patients (118 male; mean age, 71±8 years old) were treated by hybrid repair with extraanatomic reconstruction of 657 renal and mesenteric arteries (mean 3.2 vessels/patient). Mean aneurysm diameter was 6.6±1.3 cm. Thoracoabdominal aortic aneurysms were identified in 163 (78%) patients and pararenal aneurysms in 45 (22%). A single-stage repair was performed in 92 (44%) patients. The iliac arteries were the most common source of inflow (n=132; 63%), and most (n=150; 72%) had 3 or more bypasses. There were 30 (14%) early deaths, ranging widely across sites (0%-21%). A Society of Vascular Surgery comorbidity score >15 was the primary predictor of early mortality (P<0.01), whereas mortality was 3% in a score ≤9. Early complications occurred in 140 (73%) patients and included respiratory complications in 45 patients (22%) and spinal cord ischemia in 22 (11%), of whom 10 (45%) fully recovered. At 5 years, survival was 61±5%, primary graft patency was 90±2%, and secondary patency was 93±2%. The most significant predictor of late mortality was renal insufficiency (P<0.0001). CONCLUSIONS: Mortality after hybrid repair and visceral debranching is highly variable by center, but strongly affected by preoperative comorbidities and the centers' experience with the technique. With excellent graft patency at 5 years, the outcomes of hybrid repair done at centers of excellence and in carefully selected patients may be comparable (or better) than traditional open or even totally endovascular approaches. However, in patients already considered as high-risk for surgery, it may not offer better outcomes.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Aneurisma da Aorta Torácica / Implante de Prótese Vascular / Procedimentos Endovasculares Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Aneurisma da Aorta Torácica / Implante de Prótese Vascular / Procedimentos Endovasculares Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2022 Tipo de documento: Article