Endovascular repair of the aneurysms of descending thoracic aorta and abdominal aorta in the same sitting

We are concerned about many issues if there is a patient with Thoracic and abdominal aorta aneurysm asking for the Endo vascular repair of the aneurysms aneurysm in the same sitting. Paraplegia is always a concern when a large extent aorta is covered by the endograft. Recently I, myself along with a cardiologist repaired both the aneurysms in the same sitting but we preserved the left subclavian artery (Chimney) and left internal iliac artery with a hope to avoid the paraplegia. We noted that it was also done in  other centers, with minimal morbidity ( see the reference below). There is also concern about the amount of contrast injection and overload. But for the patient it may be convenient to get the both repaired in one sitting. Similarly groin exploration by the vascular surgeon may be difficult and time consuming during the second time.  One has to certainly weigh the benefits and risks of repairing the both aneurysms in one sitting.

Reference:

Interact Cardiovasc Thorac Surg. 2011 Feb 5. 

Stenting of the descending thoracic aorta: a 6-year single-center experience.Matsagkas MI, Kirou IE, Kouvelos G, Arnaoutoglou EM, Papakostas JC, Katsouras C, Papadopoulos G, Michalis LK. Department of Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece. Objectives: The aim of this study was to review the six-year results of the endovascular repair of descending thoracic aortic pathologies, reporting the early perioperative outcomes as well as the mid-term follow-up of the treated patients. Methods: Fifty-five consecutive patients who underwent endovascular repair for thoracic aortic pathology (29 aneurysms, 17 acute thoracic aortic syndromes, and six traumatic aortic ruptures) during a six-year period were retrospectively reviewed. From these patients, 30 (54.5%) were treated electively and 25 (45.5%) on an emergency basis. In eight cases (14.5%) there was a need for left subclavian artery orifice overstenting. In seven patients (12.7%) an abdominal aortic lesion was simultaneously treated, while three more patients (5.5%) had previously had their abdominal aortic aneurysm repaired. Results: The primary technical success was 92.7%. Seven patients (12.7%) underwent some operation related complication, while postoperative complications occurred in five patients (9.1%), namely four myocardial infarctions, one acute respiratory distress syndrome and two delayed parapareses resulting in an overall incidence of neurological complications of 3.6%. The combined 30-day and in-hospital mortality was 9.1%, exclusively related to patients treated emergently (P=0.01). In a mean follow-up period of 34 months there were six deaths, and the overall cumulative survival at four years was estimated at 72.6%. Only one type II endoleak was observed one month after the procedure and it spontaneously disappeared 18 months later. Conclusions: The endovascular repair of descending thoracic aortic pathologies seems to be a well-established method, with favorable morbidity and mortality rates, at least for 30 days and in the mid-term. Taking into account the potential of a wide application of the endovascular technique in many vascular centers, stenting of the thoracic aorta might offer an overall better solution for patients suffering from these devastating pathologies. Keywords: Endovascular repair; Descending thoracic aortic pathology; Stent-graft.