초록접수 현황
| 15F-086 | 포럼 발표 |
Open Conversion after Thoracic Endovascular Aortic Repair
우원기, 윤영남, 장병철, 주현철
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Background : With the increasing use of endovascular aortic repair, interest in open repair after aortic stent-grafting is increasing. We retrospectively reviewed open repair cases with complications following thoracic endovascular aortic repair (TEVAR).
Methods : TEVAR due to aortic aneurysm and dissection was performed in 488 patients between 1991 and 2015. A retrospective review of patients with open conversion after TEVAR was conducted. Patient demographics, reason of conversion, operative technique and operative outcomes were collected. The mean follow-up duration was 49.6 months (range 0 – 172 months)
Results : Twenty four of these patients (4.9%) required open conversion. The mean interval to open conversion after TEVAR was 35 months (range, 0 - 123) and early conversion within 1 month was 16.7% (4/24). Indications of open conversion included type I endoleak (n=8), retrograde type A dissection (n=4), new developed intimal tear (n=3), newly developed dissection (n=2), aneurysm enlargement without endoleak (n=1), stent migration and fracture (n=2), stent-graft infection (n=3) and failed stent implantation (n=1). In-hospital mortality was 12.5 % (3/24). One patient with retrograde type I dissection died of postoperative bleeding and multiorgan failure. Two other patients died of bleeding due to distal aortic anastomosis site rupture and pneumonia, respectively. Reoperation for postoperative bleeding occurred in 5 patients (20.8%) and there were two neurologic complications (1 paraplegia, 1 stroke). During follow-up periods, one patient required additional intervention because of graft infection. The 10-year survival rate was 74.8 ± 10.5 % and 10-year free from reintervention was 83.9 ± 8.8%.
Conclusion : Open conversion after failed TEVAR remains important issue in the future. Open conversion due to complication after TEVAR can be performed successfully with encouraging results. Lifelong surveillance is justified and early decision for open conversion, if indicated, is necessary to achieve the better outcome.
Methods : TEVAR due to aortic aneurysm and dissection was performed in 488 patients between 1991 and 2015. A retrospective review of patients with open conversion after TEVAR was conducted. Patient demographics, reason of conversion, operative technique and operative outcomes were collected. The mean follow-up duration was 49.6 months (range 0 – 172 months)
Results : Twenty four of these patients (4.9%) required open conversion. The mean interval to open conversion after TEVAR was 35 months (range, 0 - 123) and early conversion within 1 month was 16.7% (4/24). Indications of open conversion included type I endoleak (n=8), retrograde type A dissection (n=4), new developed intimal tear (n=3), newly developed dissection (n=2), aneurysm enlargement without endoleak (n=1), stent migration and fracture (n=2), stent-graft infection (n=3) and failed stent implantation (n=1). In-hospital mortality was 12.5 % (3/24). One patient with retrograde type I dissection died of postoperative bleeding and multiorgan failure. Two other patients died of bleeding due to distal aortic anastomosis site rupture and pneumonia, respectively. Reoperation for postoperative bleeding occurred in 5 patients (20.8%) and there were two neurologic complications (1 paraplegia, 1 stroke). During follow-up periods, one patient required additional intervention because of graft infection. The 10-year survival rate was 74.8 ± 10.5 % and 10-year free from reintervention was 83.9 ± 8.8%.
Conclusion : Open conversion after failed TEVAR remains important issue in the future. Open conversion due to complication after TEVAR can be performed successfully with encouraging results. Lifelong surveillance is justified and early decision for open conversion, if indicated, is necessary to achieve the better outcome.
책임저자: 주현철
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
연락처 : 우원기, Tel: 010-8222-0983 , E-mail : 1keywoo@yuhs.ac
