Systematic Review of Open Versus Endovascular Repair of Thoracoabdominal Aneurysms

Thoracoabdominal aneurysm (TAAA) is an aneurysmal dilatation of the descending thoracic and abdominal aorta. Given the high mortality and morbidity associated with open repair of TAAA a thoracic endovascular aortic aneurysm repair (TEVAR) has been proposed. We performed a systematic review of existing studies on open repair vs TEVAR between 2000-14 with regards to mortality and neurological complications. Eleven studies were reviewed with a total of 1,713 and 317 patients for the open and TEVAR group, respectively. Our results demonstrate (open vs TEVAR): overall 30-day mortality of 7.8% vs 7.0% and spinal cord ischemia (SCI) of 4% vs 10.4%. The TEVAR group included older and unfit patients with more comorbidities. Only one study in the open group reported a stroke rate of 3.2%. Overall stroke rate for the TEVAR group was 1%. Mortality and SCI rates were not different between two groups. While endovascular repair of TAAA has acceptable short-term outcomes, open repair is not obsolete and should be offered to younger, relatively fit patients.