In the ongoing transition from open repair to evar with thoracoabdominal aneurysms (taa as) what situations and lesions still are be

1. In the ongoing transition from open repair to
EVAR with thoracoabdominal aneurysms
(TAAAs): what situations and lesions still are
best treated by open surgery
Michael Jacobs, Maastricht, the Netherlands and Aachen, Germany

5. 2003: When is TEVAR contra indicated ?
• Thoraco abdominal aortic aneurysms (TAAA)
• Post dissection descending aneurysms
• Post dissection TAAA
• Aorto bronchial fistula
• Aorta esophageal fistula
• Connective tissue disease related aneurysms
• Young age

6. 2013: When is TEVAR/FEVAR contra indicated ?
• Thoraco abdominal aortic aneurysms (TAAA)
• Post dissection descending aneurysms
• Post dissection TAAA
• Aorto bronchial fistula
• Aorta esophageal fistula
• Connective tissue disease related aneurysms ?
• Young age ?

10. IMAGINE THIS OCCURS AT THE PROXIMAL
SEALING ZONE …

13. Open TAAA repair: a huge surgical trauma

14. „Acceptable“ clinical outcome
of TAAA surgery
• Correct indication and well selected patient
• Extensive experienced team, high volume
• Infrastructure: ECC, neuromonitoring, ICU
• New strategy: sequential surgical procedures

15. Annual TAA(A) activities
Thoracic 50 90% endo
10% open
Thoraco-abdominal 90 50% endo
50% open

16. Even with extensive experience and high
volume …
• Mortality 10%
• Unexpected morbidity
• Delayed, unexpected morbidity
• Very demanding surgery
• However, if successful, patient‘s future is good

18. Decision making
• Open TAAA: young patients, CTD, failed endo
• Endo TAAA: all other patients
• No treatment at all: when the risk of endo or open
surgery is higher than the risk of rupture (age, renal
failure, cardio-pulmonary, .. )
• Open versus endo versus no intervention:
„eye-test“

19. „EYE-TEST is an accurate diagnostic
tool with high predictive value for
surgical outcome“