Total endovascular repair for thoracoabdominal aortic aneurysms Open surgery for TAAA has risks but hybrid and endovascular techniques show promise. TEVAR is increasingly used in high-risk patients but experience is limited, technology is complex and expensive, and long-term outcomes are uncertain. Successful TEVAR requires detailed imaging analysis, device planning, technical skill, and a multidisciplinary team to address complications. Further improvements in speed, flexibility, and device profiles could make endovascular repair the standard approach for TAAA in the future.

1. Total endovascular repair for thoracoTotal endovascular repair for thoraco
abdominal aortic aneurysmsabdominal aortic aneurysms
Michael Jacobs, Geert Willem Schurink

2. Maastricht University Medical
Center, the Netherlands
University Hospital Aachen,
Germany

3. Open surgery for TAAA has always been the
untill hybrid and endo techniques were introduced

4. TAAA Surgery: always some problem …

5. Is TEVAR already applicable for TAAA ?
Limited experience, mainly in
high surgical risk patients
Complex technology, very
expensive
Questionable longevity of
material (interconnections)
Serious complications
Unclear indications
But, ……it will eventually
dictate the future

6. Furthermore,….endosurgery of TAAA is more
than introducing a device
Judging CT-MRA images
Performing adequate measurements
Designing an endovascular/hybrid plan
Execute the plan
Understanding and treating complications
Part of a multidisciplinary team

7. SHORT INFRARENAL NECK ANDSHORT INFRARENAL NECK AND
JUXTARENAL ANEURYSMSJUXTARENAL ANEURYSMS

8. Workstation is essentialWorkstation is essential

9. Axial versus MPR measurementsAxial versus MPR measurements
10-11mm distance 6mm distance

10. Clock positionClock position
9:30 hr 3:00 hr

11. Central Lumen Line reconstructionCentral Lumen Line reconstruction

12. Relative Central lumen line distanceAfstandRelative Central lumen line distanceAfstand

13. Distance Reference LineDistance Reference Line
LOWER
COELIAC 00
MID SMAMID SMA
LOWER SMALOWER SMA
MID RIGHT RENALMID RIGHT RENAL
MID LEFT RENALMID LEFT RENAL
1313
1818
2828
3434

22. Thoracoabdominal Aortic AneurysmThoracoabdominal Aortic Aneurysm

23. ScallopScallop
FenestrationsFenestrations
Atrium V12
stent

24. Internal-external
Branch
Helical Branch

26. SMA
Celiac axis
Right renal
Left renal
2 cm

27. Celiac
axis
SMA
Right renal
Left renal
2 cm

28. 8 Fr Flexor
Sheath
12 Fr Flexor
Shleath

36. Type I TAAAType I TAAA
78 years;78 years; Ø80mmØ80mm

40. Man (1940)Man (1940)
TAAA IV (TAAA IV (Ø 70 mm) after aortic arch andØ 70 mm) after aortic arch and
descending thoracic repairdescending thoracic repair

43. TAAA repairTAAA repair
Mortality (30day) 13% 15% 5,4%
Paraplegia 4,5% 8,4% 2,7%
MI 3,6% ? 5,4%
Dialysis 1,8% 4% 1,4%
1) Maastricht Open Experience. Jacobs et al. JVS 2006
2) St Mary’s/Heidelberg/Munich. Drinkwater et al. EJVES 2009
3) Cleveland Clinic, presented at AATS, 2006
Open
repair
(n=112)
Hybrid
repair
(n=107)
Endo
repair
(n=73)

44. ConclusionConclusion
Will total endovascular repair be
the future for TAAA?

45. It needs to be ...It needs to be ...
Faster
In situ fenestration??
Better
More flexible
Low(er) profile endoprostheses