Abstract
Objective: To evaluate the early and mid-term results of simultaneous TEVAR and EVAR operations for combined thoracic and abdominal or thoracoabdominal aortic aneurysm. Methods: Between December 2007 and September 2009, we performed TEVAR in 57 patients in our hospital. Among these, we performed simultaneous TEVAR and EVAR operations in 9 patients (15.7%). The median age was 78 years (range, 57–83). There were 7 men and 2 women and the median follow-up period was 19.8 months (range, 10.5–29.6). Combined TAA (distal arch; n=3, proximal descending arch; n=1, chronic type B dissection; n=2). AAA was diagnosed in 6 patients, TAAA and AAA were diagnosed in 2 patients, and acute type B dissection and AAA were diagnosed in 1 patient. Results: The thoracic aortic stent grafts used were a TAG (n=8) and a Najuta (n=1). The abdominal aortic stent grafts used were the Excluder (n=8) and the Powerlink (n=1). Three patients underwent a debranching procedure first, followed by TEVAR and EVAR. RSCA to LCCA and LSCA bypass (n=1), LCCA to LSCA bypass (n=1), REIA to RRA, LEIA to SMA and LRA bypass (n=1) were performed in these patients. The intercostal arteries at the T8 to T12 levels (Adamkiewicz artery was apparent) were covered in 4 patients. The LSCA was covered in 2 patients, and the unilateral IIA was covered in 2 patients. There was no simultaneous covering of the LSCA or ipsilateral IIA. Cerebrospinal fluid (CSF) drainage was not performed in any cases. There was no occurrence of postoperative stroke or paraplegia. During the follow-up periods, there were no occurrences of Type I endoleak. Although Type II endoleak developed in 3 patients, the diameter of the aneurysms did not increase during the follow-up period. There were no instances of early or late death. Conclusion: Simultaneous TEVAR and EVAR for the treatment of combined thoracic and abdominal aortic aneurysms were safe and effective. There were no complications such as paraplegia.
