Authors: Gong Kunmei

Affiliation: Yunnan First People's Hospital

Overview of Treatment Strategies for Thoracoabdominal Aortic Aneurysm (TAAA)

This document discusses the complexities and treatment modalities for thoracoabdominal aortic aneurysms, emphasizing the challenges due to involvement of critical arteries like visceral and intercostal arteries, and compares the efficacy of open surgery, endovascular treatment, and hybrid procedures.

Epidemiology and Treatment Challenges

Thoracoabdominal aortic aneurysms pose significant challenges due to their complexity and the high risk associated with their treatment. The document describes different approaches and their suitability based on patient age and condition, noting the higher complexity and risk compared to Type A aortic dissections.

Treatment Modalities

· Open Surgery:

o Recommended for patients under 60 with good organ function, offering a definitive solution but associated with high mortality and complication rates.

· Endovascular Treatment:

o Includes techniques like fenestrated stents and parallel grafts, providing effective short-term results with long-term outcomes still under review.

· Hybrid Surgery:

o Combines elements of both open and endovascular approaches to reduce trauma but adds complexity and technical challenges.

Surgical Outcomes and Statistics

· Data from various sources highlight the outcomes of these treatments:

o A U.S. database from 2005-2010 reports a 30-day mortality of 10% for TAAA cases undergoing open surgery.

o Hybrid surgery approaches from 2001-2012 show a perioperative mortality rate of 13.5% among high-risk patients.

Future Directions and Clinical Insights

· The document reflects on the need for continued development in surgical techniques and technologies to improve safety and efficacy, particularly for high-risk and elderly patients.

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