A 10-year institutional experience with open branched graft reconstruction of aortic aneurysms in connective tissue disorders versus degenerative disease

Abstract Objective Aortic reconstruction for complex thoracoabdominal aortic aneurysms (TAAAs) can be challenging, especially in patients with connective tissue disorders (CTDs) in whom tissue fragility is a major concern. Branched graft reconstruction is a more complex operation compared with inclu...

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Bibliographic Details
Published in:Journal of vascular surgery 2017-11, Vol.66 (5), p.1406-1416
Main Authors: Hicks, Caitlin W., MS, MD, Lue, Jennifer, BA, Glebova, Natalia O., MD, PhD, Ehlert, Bryan A., MD, Black, James H., MD, FACS
Format: Article
Language:English
Subjects:
Adult
Aged
Aneurysm, Dissecting - diagnostic imaging
Aneurysm, Dissecting - etiology
Aneurysm, Dissecting - mortality
Aneurysm, Dissecting - surgery
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic Aneurysm, Thoracic - etiology
Aortic Aneurysm, Thoracic - mortality
Aortic Aneurysm, Thoracic - surgery
Baltimore
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Blood Vessel Prosthesis Implantation - mortality
Connective Tissue Diseases - complications
Connective Tissue Diseases - diagnosis
Connective Tissue Diseases - mortality
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Endovascular Procedures - mortality
Female
Graft Occlusion, Vascular - etiology
Humans
Male
Middle Aged
Prosthesis Design
Retrospective Studies
Risk Factors
Stents
Surgery
Time Factors
Treatment Outcome
Vascular Patency
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Summary:Abstract Objective Aortic reconstruction for complex thoracoabdominal aortic aneurysms (TAAAs) can be challenging, especially in patients with connective tissue disorders (CTDs) in whom tissue fragility is a major concern. Branched graft reconstruction is a more complex operation compared with inclusion patch repair of the aorta but is frequently necessary in patients with CTDs or other pathologies because of anatomic reasons. We describe our institutional experience with open branched graft reconstruction of aortic aneurysms and compare outcomes for patients with CTDs vs degenerative pathologies. Methods We retrospectively analyzed all patients undergoing open aortic reconstruction using branched grafts at our institution between July 2006 and December 2015. Postoperative outcomes, including perioperative morbidity and mortality, midterm graft patency, and the development of new aneurysms, were compared for patients with CTD vs degenerative disease. Results During the 10-year study period, 137 patients (CTD, 29; degenerative, 108) underwent aortic repair with branched graft reconstruction. CTD patients were significantly younger (39 ± 1.9 vs 68 ± 1.0 years; P  < .001) and had fewer comorbidities (hypertension, chronic obstructive pulmonary disease, coronary artery disease; P  < .05) but a higher prevalence of aortic dissections (55% vs 16%; P  < .001) and aneurysms involving the thoracic aorta (90% vs 60%; P  = .003) than patients with degenerative disease. Perioperative mortality (CTD: 10% [n = 3] vs degenerative: 6% [n = 6]; P  = .40) and any complication (62% vs 55%; P  = .47) were similar between groups. At a median follow-up time of 14.5 months (interquartile range: 6.5, 43.9 months), CTD patients were more likely to develop both new aortic (21%) and nonaortic (14%) aneurysms compared with the degenerative group (7% and 4% for aortic and nonaortic aneurysms, respectively; P  = .02). Loss of branch graft patency occurred in 0 of 99 grafts (0%) in CTD patients and in 13 of 167 grafts (7.8%) in degenerative disease patients ( P  = .005). Loss of branch graft patency occurred most commonly in left renal artery bypass grafts (77%) and was clinically asymptomatic (creatinine: 1.77 ± 0.13 mg/dL currently vs 1.41 ± 0.25 preoperatively; P  = .22). Conclusions CTD patients with aortic aneurysms who undergo open branched graft reconstruction have reasonable outcomes compared with patients with degenerative pathology, including better branched graft patency and
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2017.03.451