Open surgical repair of descending thoracic aortic aneurysms in the endovascular era: a 9-year single-center study.

The purpose of this study was to present a single center's experience with elective treatment of descending thoracic aortic aneurysms (DTAAs) in the endovascular era. From July 1997 to May 2005, we operated on 173 patients for DTAA. A total of 52 patients (30.1%) underwent endovascular stent-graft repair (group I). Endovascular repair was carried out exclusively in high-surgical risk patients in whom preoperative spinal cord arteriography usually demonstrated that the origin of the Adamkiewicz artery was located outside the zone to be covered by the stent graft. The remaining 121 patients (69.9%) underwent open surgical repair (group II), with partial cardiopulmonary bypass in 78 cases (64.5%) and deep hypothermic circulatory arrest in 43 (35.5%). The two treatment groups differed significantly with regard to age, prevalence of chronic obstructive pulmonary disease, number of aneurysms involving the upper segment or full length of the descending thoracic aorta, and percentage of patients in whom spinal cord arteriography was either deemed unnecessary or demonstrated that the origin of the Adamkiewicz artery was located within the coverage zone. In-hospital mortality was 15.4% (8/52) in group I vs. 5.0% (6/121) in group II (p = 0.02). Five deaths after endovascular repair were due to technical causes. All neurological deficits due to spinal cord ischemia (9/121, 7.4%) including 3.3% of irreversible flaccid paraplegia occurred in group II (p = 0.04). The findings of this study show that open surgical repair achieves excellent results when high-risk surgical candidates are recommended for endovascular repair. However, since preoperative spinal cord arteriography was a selection criterion for endovascular repair, the improvement in mortality was accompanied by a concentration of spinal cord ischemic complications in the patients having open surgical repair. The high mortality associated with endovascular repair in our series should decrease as deployment skill and endovascular technology improve.