Branched Endovascular Aortic Repair for Thoracoabdominal Aortic Aneurysms Treated by Single Step or Staged Procedures with Aneurysm Sack Perfusion - A 10 Years Single Center Experience

Introduction - Branched endovascular aortic repair (BEVAR) has become an accepted option for treatment of thoracoabdominal aortic aneurysms (TAAA). Staged procedures with a non-completed open branch for temporary aneurysm sac perfusion (TASP) was shown to reduce the risk of spinal cord ischemia (SCI) in patients with extended aortic aneurysmal disease. However, further results on a larger patient cohort with analysis of perioperative results, neurologic complications and follow-up data are required. Methods - Patients with TAAA were treated with branched EVAR between 09/2007 and 02/2017 using a single step or staged procedure with temporary aneurysm sac perfusion. TASP side branch completion was intended within 1-12 months. Postoperative spinal cord motor dysfunction was classified according to the modified Tarlov scale. Results - 155 patients were treated with BEVAR, 69 without an aneurysm sac perfusion (single step) and 86 with the open branch TASP procedure. Technical success, duration of intervention, contrast volume, branch patency rates and the rate of early reinterventions were similar in both groups. In 10 patients the TASP side branch was not completed for various reasons. Temporary aneurysm sac perfusion failed in two patients (2.3 %), one of them developed SCI. The risk of paraplegia (d30) was reduced in the open branch TASP group (4.7 %) in comparison to the single step group (23.2 %, p=0.001). Risk factors for postoperative SCI were intraoperative hypotension (p=0.008), anemia (p=0.007) and extended aortic repair (p=0.007). Perioperative mortality was similar in both treatment groups (8.7 % vs 9.3 %) with correlation to age (p=0.017), intraoperative hypotension (p=0.006) and postoperative anemia (p=0.001). Conclusion - Staged procedures using the open branch concept with temporary aneurysm sac perfusion improves neurologic outcome after branched EVAR for TAAA. Perioperative management and monitoring of side branch perfusion is important.