Kensuke Ozaki
Current Position
Vice Chief
Kawasaki Aortic Center, Kawasaki Saiwai Hospital
Thoracic Aorta Session

Topic: Open repair to rescue thoracic endograft complications


Objective: Along with increasing of horacic endograft aortic repair(TEVAR), there has been an increase in the number of additional treatments for complications such as endoleak, re-enlargement and device infection. It is not a few cases which are difficult to treat with endovascular therapy and required open conversion. We investigated the indications, surgical strategies, and results of open conversion after TEVAR at our center.
Methods: 53 patients who underwent open aortic surgery after TEVAR were identified by databases collected retrospectively.
Results: Between July 2012 and August 2021, 53 patients were underwent open aortic surgery after TEVAR. The mean interval to open repair after TEVAR was 24months (range8-57 months). Total aortic arch replacement with sternotomy (n=15), total arch and descending aortic replacement through left thoracotomy(n=7), descending aortic replacement(n=15), and thoracoabdominal aortic replacement(n=16) were performed after previous TEVAR. The indications for open repair included type1 endoleak(n=16), type2 endoleak(n=5), retrograde aortic dissection(n=7), chronic aortic dissection with persistent growth of false lumen(n=15), and stent-graft infection(n=4). 49% had done so in an emergency. All patients required extra corporeal circulation and 70% required hypothermic circulatory arrest. 30-day mortality was 3(3.7%), 5(9.4%) had stroke, 2(3.7%) paraplegia was occurred, 3(5.7%) patients required tracheostomy, and none required dialysis. The 1-year survival rate was 92.5%, and the 3-years survival rate was 88.5%.
Conclusions: Open repair to rescue TEVAR complications can be performed successfully with acceptable result, despite any complexity of TEVAR. This radical open repair after TEVAR is likely to increase in the future.