Treatment of acute thoracoabdominal aortic aneurysms

INTRODUCTION: Acute thoracoabdominal aortic aneurysms (aTAA) are an uncommon and lethal condition associated with an extremely high mortality and morbidity rates. Both endovascular and open repair may be offered in emergency. aim of this study is to report our results and present a literature review regarding endovascular and open surgical repair of aTAA. EVIDENCE ACQUISITION: MEDLINE, EMBASE, and the Cochrane Library CENTRAL databases were searched from 1991 to 2016. Also, a retrospective analysis of all consecutive patients who underwent aTAA open and endovascular treatment at our Institution between 1993 and 2016 was performed. EVIDENCE SYNTHESIS: From the literature search 671 patients who underwent open repair and 26 patients treated with endovascular techniques were found. Contained rupture (56.98%) was the most common clinical presentation of aTAA and operative mortality ranged from 11.7% to 27.4%. The overall 30-days survival rate ranged from 73.5% to 87.5%. At 5-year and 10-years, survival rate was 48% and 35%, respectively. At our Institution, 12 patients were operated for an aTAA; mortality rate was 58.3% (7/12 cases). Since 2014, 7 additional patients have been treated by means of endovascular techniques. The 30-day survival was 100%. CONCLUSIONS: aTAAA is a threatening condition, however, the overall literature results do not reflect this scenario because stable patients and cases limited to the descending thoracic aorta are usually considered together with TAA ruptures. The endovascular treatment may be a very valuable alternative although it is still limited by anatomic and logistic issues and only case reports and short series are reported in literature.