A comparison of thoracoabdominal aortic aneurysms open repair in patients with or without “shaggy aorta” |
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| Affiliation: | 1. CHU de Bordeaux, Infectious and Tropical Diseases Department, Bordeaux, France;2. University of Bordeaux, UMR 5234 CNRS, Microbiologie Fondamentale et Pathogénicité, Antimicrobial Resistance in Mycoplasmas and Gram-Negative Bacteria, Bordeaux, France;3. University of Bordeaux, UMR 5234 CNRS, Microbiologie Fondamentale et Pathogénicité, Aquitaine Microbiologie, Bordeaux, France;4. CHU de Bordeaux, Bacteriology Department, Bordeaux, France;5. CHU de Bordeaux, Vascular Surgery Department, Bordeaux, France;1. Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia;2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;3. Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden;4. Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;5. Faculty of Medicine, University of Belgrade, Belgrade, Serbia;6. Clinic for Vascular and Endovascular Surgery, Serbian Clinical Centre, Belgrade, Serbia;1. Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, Antibes, France;2. Université Côte d''Azur, INSERM U1065, C3M, Nice, France;3. Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany;4. Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK;5. Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK;6. Laboratory of Applied Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, Paris, France;7. Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France;8. AI Institute 3IA Côte d’Azur, Université Côte d’Azur, Côte d’Azur, France;1. Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France;2. UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France;1. Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK;2. Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK;3. Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal;4. NOVA Medical School, Universidade NOVA de Lisboa, Portugal;5. Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden;6. Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France;7. Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France;8. Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France;9. Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France;10. Vascular Centre, Skåne University Hospital, Malmö, Sweden;11. Department of Vascular Surgery, Kantonsspital St. Gallen, University of Bern, Bern, Switzerland;12. Department of Vascular Surgery, University of Patras Medical School, Patras, Greece;13. Department of Vascular Surgery, Maastricht University Medical Centre and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands;14. Department of Vascular Surgery, Copenhagen University Hospital- Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;15. Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy;p. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy;q. Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland;r. Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK;s. Centre for Surgical Research, University of Bristol, Bristol, UK;t. Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium;u. Department of Surgery and Peri-operative Sciences, Umeå University, Umeå, Sweden;v. Department of Biomedical and Preclinical Sciences, University of Liège, Belgium;w. GIGA Cardiovascular Sciences, University of Liège, Belgium;x. Department of Information System Management, University Hospital of Liège, Belgium;1. Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece;2. Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece;3. Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;4. Department of Radiology, Aristotle University of Thessaloniki, School of Medicine, AHEPA University Hospital, Thessaloniki, Greece;5. 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece |
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| Abstract: | ObjectiveIn the field of thoracoabdominal aortic aneurysm (TAAA) open surgical repair (OSR), some preoperative characteristics are established risk factors for adverse outcomes, whereas others are supposed to be relevant, but their role still need to be defined; among them, the presence of “shaggy aorta” (SA), an extensive and irregular atheroma within the aorta. The aim of this study is to report the results of a single-center large cohort of patients treated with OSR for TAAA with SA, comparing the outcomes with patients affected by TAAA without SA, and analyzing the impact of the scores for SA on the outcomes.MethodsAll consecutive patients receiving OSR for TAAA between 2012 and 2021 were retrospectively analyzed. Clinical data from patients with degenerative TAAA were included and analyzed for preoperative characteristics and postoperative outcomes; patients with ruptured TAAA, and patients with aortic dissection were excluded from the analysis. Patients with degenerative aortic aneurysm, thrombus measurement in non-aneurysmal aortic segments (≤40 mm), atheroma thickness ≥5 mm, and finger-like thrombus projection were included in the SA group, whereas the others were included in the non-shaggy aorta group (NSA group). The SA group and NSA group were compared using a propensity-matched comparison. Preoperative computed tomography scans of patients in the SA group were also stratified according to SA grading scores.ResultsA total of 58 patients with SA were identified (male, n = 43 [74.1%], mean age 70.1 ± 7.8 years) among 497 patients with TAAA treated with open surgical repair. After propensity matching, there were 57 patients in the SA group and 57 in the NSA group with correction of all differences in baseline characteristics. Patients in the SA group presented significantly higher in-hospital mortality (SA group, 14.0% vs NSA group, 3.5%; P = .047), postoperative acute renal failure (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease [RIFLE], 3-5) (SA group, 21.1% vs NSA group, 5.3%; P = .013), and postoperative embolization (SA group, 28.1% vs NSA group, 8.8%; P = .008). Spinal cord ischemia and stroke rate were not significantly influenced by the presence of SA. In the SA group, 16 patients (27.6%) with end-organ embolization were compared with 42 patients (72.4%) without a documented embolization considering the grade of aortic “shagginess” and no significant difference was identified (P = .546).ConclusionsDespite a better knowledge of the SA disease, new classifications, and intraoperative adjuncts, TAAA patients with SA treated with OSR have worse postoperative outcomes if compared with patients without SA. The presence of SA is a risk factor itself, whereas the grade of “shagginess” seems not to impact on postoperative outcomes. |
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| Keywords: | Embolic complications Open repair Shaggy aorta TAA Thoracoabdominal aortic aneurysm Thrombus |
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