Procedural staging for endovascular repair of extensive TAAA gains CX audience backing

Clockwise from top left: Roger Greenhalgh (London, UK); Stéphan Haulon (Paris, France); Michael Borger (Leipzig, Germany); Joseph Coselli (Houston, USA); Gustavo Oderich (Houston, USA); Luca Bertoglio (Milan, Italy).

A poll conducted at CX Aortic Vienna 2021 (5–7 October, broadcast) saw an overwhelming majority of attendees vote in favour of staging endovascular thoracoabdominal aortic aneurysm (TAAA) repair procedures to reduce the rate of spinal cord ischaemia (SCI), a known complication after endovascular treatment. This followed a presentation from Luca Bertoglio (Milan, Italy), who demonstrated the benefits of both historical staging and planned procedural staging in reducing permanent SCI with data from 240 patients, and preceded an edited case from Gustavo Oderich (Houston, USA), who has played a key role in an emerging shift away from routine cerebrospinal fluid (CSF) drainage in endovascular TAAA repair due to its associated complications.

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Stéphan Haulon (Paris, France) and co-moderator Michael Borger (Leipzig, Germany) agreed that, in practice, they would also prefer to use procedural staging where possible. This preceded the audience poll, which saw 89% of attendees vote that staging procedures makes sense as a means of reducing SCI after elective fenestrated/branched endovascular aneurysm repair (F/BEVAR) procedures.

In a subsequent discussion, Haulon noted that there has recently been a shift away from CSF drainage in endovascular TAAA repair due to the perceived benefits being outweighed by the potential morbidity risks. Bertoglio agreed with this sentiment, but also noted that CSF drainage may be advisable in aortic centres with experienced anaesthesiology teams who can perform drainage at any time, and is still preferred in open surgery too.

Registrants can view Bertoglio’s presentation on demand here.

Later in this session, Oderich presented an edited case demonstrating BEVAR using a total transfemoral approach. He reported no technical defects or endoleaks, adding that the patient was free from postoperative complications and was discharged after one week.

Registrants can view Oderich’s presentation on demand here.

Elsewhere, in a first-to-podium presentation of a systematic review and meta-analysis based on existing literature, Dittmar Böckler (Heidelberg, Germany) reported outcomes relating to endograft migration after thoracic endovascular aortic repair (TEVAR) procedures that included 10 studies. He noted a 4% pooled incidence of migration, a 28% rate of migration-related reintervention, a 21% rate of migration-related morbidity and a 3% rate of migration-related mortality.

Discussing these findings, he concluded that migration-related reintervention rates appear to be higher than general reintervention rates after TEVAR, but that migration-related mortality rate is lower compared to other post-TEVAR complications. Böckler added that post-TEVAR migration “needs more attention”, with this study underlining the importance of lifelong surveillance following the procedure.

Registrants can view Böckler’s presentation on demand here.

Joseph Coselli (Houston, USA) later presented the outcomes of 3,688 open TAAA repair surgeries performed between 1986 and 2021—noting that the 90% rate of freedom from repair failure at 15 years is “excellent” and indicates that open surgery is durable for this indication.

Registrants can view Coselli’s presentation on demand here.


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