Key result
Endovascular staged repair of thoraco-abdominal aortic aneurysms was associated with a significantly higher rate of spinal cord ischemia (9.8%) compared to open repair (1.4%).
Why the study?
Staged procedures benefit medium- to high-risk Crawford extent I-III TAAA repair, but the optimal approach—open, endovascular, or hybrid—regarding spinal cord ischemia and long-term mortality had not been compared.
Does the surgical approach (open, endovascular, or hybrid) affect the risk of spinal cord ischemia and long-term mortality in patients undergoing staged thoraco-abdominal aortic aneurysm repair?
Meta-Analysis (n=924)
Yes
Does the surgical approach (open, endovascular, or hybrid) affect the risk of spinal cord ischemia and long-term mortality in patients undergoing staged thoraco-abdominal aortic aneurysm repair?
Absolute Event Rate: 9.8% vs 1.4%
p-value: p=<0.01
In staged thoraco-abdominal aortic aneurysm repair, the endovascular approach is associated with a higher risk of spinal cord ischemia and long-term mortality compared to open repair, despite open repair having a higher 30-day mortality.
Staged endovascular TAAA repair shows higher SCI but lower early mortality than open approaches; leaves optimal strategy selection open pending randomized trials.
Background: Staged procedures are one strategy found to be beneficial for medium- to high-risk Crawford extent I-III thoraco-abdominal aortic aneurysm (TAAA) repair patients and may be performed through a variety of techniques. This review sought to compare the primary outcomes of spinal cord ischemia (SCI) and long-term mortality between three cohorts grouped by approach: open, endovascular, and hybrid. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 919 references were extracted from a search of three online databases (Embase, PubMed, Scopus). Following application of inclusion/exclusion criteria and data extraction, quantitative meta-analysis was undertaken utilizing a random effects model. Kaplan-Meier (KM) curves were digitized and aggregated to graph estimated survival. Results: A total of 20 studies representing 924 patients were included. SCI was highest in the endovascular group, at 9.8% of weighted means, followed by hybrid, and open groups at 3.2% and 1.4%, respectively. However, 30-day mortality was highest in the open group at 6.0%, followed by the hybrid group at 3.8%, and endovascular at 3.6%. Aggregated long-term survival estimations are shown graphically, extending to 5 years for open and endovascular cohorts, and 3 years for the smaller hybrid cohort. Conclusions: While all cases incorporated spinal drainage, monitoring and staging for spinal protection, there is innate difference in approach when examining for cord ischemia. This systematic review and meta-analysis of staged TAAA repair describes the first comparison between cohorts of open and endovascular approach, revealing the increased risk of SCI and long-term mortality in endovascular repair.
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Muston et al. (2023) conducted a meta-analysis in Thoraco-abdominal aortic aneurysm (TAAA) (n=924). Endovascular staged repair vs. Open staged repair was evaluated on Spinal cord ischemia (SCI) (p=<0.01). Endovascular staged repair of thoraco-abdominal aortic aneurysms was associated with a significantly higher rate of spinal cord ischemia (9.8%) compared to open repair (1.4%).
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