HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Scott A. LeMaire Joseph S. Coselli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by LeMaire, S. A. Articles by Coselli, J. S. Search for Related Content PubMed PubMed Citation Articles by LeMaire, S. A. Articles by Coselli, J. S. Related Collections Great vessels Peripheral vascular

Eur J Cardiothorac Surg 2004;26:599-607
© 2004 Elsevier Science NL

Deployment of balloon expandable stents during open repair of thoracoabdominal aortic aneurysms: a new strategy for managing renal and mesenteric artery lesions

Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine and The Methodist DeBakey Heart Center, 6560 Fannin Street, Suite 1100 Houston, TX 77030, USA

Received 15 October 2003; received in revised form 5 April 2004; accepted 21 April 2004.

^* Corresponding author. Tel.: +1-713-790-4313; fax: +1-713-790-0202
e-mail: slemaire{at}bcm.tmc.edu

Objective: Patients undergoing graft repair of thoracoabdominal aortic aneurysms (TAAAs) often require concomitant correction of ostial stenoses or dissection involving visceral branches. The purpose of this report is to describe our initial experience with a new strategy for addressing these lesions during open TAAA repair—direct deployment of balloon expandable stents into the renal and mesenteric arteries. Methods: Over a two-year period, 367 patients have undergone TAAA surgery. Balloon expandable stents were used to manage visceral branch lesions during open TAAA repair in 93 (25.3%) of these patients. Fifteen patients (16%) had preoperative renal insufficiency. After opening the aneurysm and exposing the branch artery ostia, premounted balloon expandable stents were deployed in the affected vessels under direct vision. Stents were deployed after an endarterectomy in 40 patients (43%). Eighty patients (86%) had stents placed in one or both renal arteries and 36 (39%) had stents placed in the celiac axis and/or superior mesenteric artery. Postoperative renal function was monitored with daily serum creatinine levels. Results: There were nine early operative deaths (10%). Two patients (2%) had bleeding complications related to stenting, one of which died after developing multiple organ failure. Twelve patients (13%) developed renal failure, eight of which required dialysis. Conclusions: This study demonstrates the feasibility of treating ostial lesions of the visceral branches with balloon expandable stents during open TAAA repair. Despite a high prevalence of preoperative renal insufficiency, the incidence of postoperative renal failure was acceptable. This new strategy may be a valuable adjunct to TAAA repair and warrants further investigation.

Key Words: Aneurysm • Aorta • Aortic dissection • Endarterectomy • Endovascular stent • Renal arteries

This article has been cited by other articles:

				J. S. Coselli and S. A. LeMaire Descending and Thoracoabdominal Aortic Aneurysms Card. Surg. Adult, January 1, 2008; 3(2008): 1277 - 1298. [Full Text]

				R. G. MacArthur, S. A. Carter, J. S. Coselli, and S. A. LeMaire Organ Protection During Thoracoabdominal Aortic Surgery: Rationale for a Multimodality Approach Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2005; 9(2): 143 - 149. [Abstract] [PDF]