Simultaneous thoracic endovascular aortic repair and endovascular aortic repair is feasible with minimal morbidity and mortality

Objective: To determine the results of simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR). Methods: Records were retrospectively reviewed. Eight patients underwent simultaneous TEVAR and EVAR between 1999 and 2010 at a single center. All patients had concomitant thoracic and abdominal aortic disease (aneurysms, penetrating aortic ulcers). Ranges for the thoracic and abdominal aneurysm diameters were 6.0 to 9.1 cm and 5.0 to 7.6 cm, respectively. Four patients were treated emergently, and the remainder had indications for simultaneous repair. The mean age was 72 years (six males). All patients had significant comorbidities. Results: Average procedural time was 173 minutes ± 25 minutes. Spinal drainage and neuromonitoring was used in all cases. Thoracic endovascular aortic repair (TEVAR) was performed prior to EVAR. Three patients required left subclavian coverage and four patients had full coverage of the thoracic aorta. Only one patient had internal iliac artery (unilateral) coverage. One patient was lost to follow-up 6 weeks following discharge. The remainder were followed between 4 and 77 months postoperatively. No patients developed acute myocardial infarction, acute renal failure, or neurologic complications, including permanent paralysis or stroke. One patient developed transient lower extremity weakness that resolved with blood pressure augmentation. Mean blood loss was 325 mL ± 137 mL. The average intensive care unit and hospital stay was 3 days and 8 days, respectively. In follow-up, one patient developed a type II endoleak that was successfully embolized. Conclusion: Combined TEVAR and EVAR can be performed successfully with minimal morbidity and mortality. In particular, in this limited series of eight patients, there have been no occurrences of lower extremity paralysis or renal failure despite a high proportion of emergent cases. When anatomically feasible, simultaneous TEVAR and EVAR can be considered as a viable alternative to staged or hybrid repair.