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Page 10 of 15 Rodrigues et al. Vessel Plus 2024;8:10 https://dx.doi.org/10.20517/2574-1209.2023.109

undergo prophylactic SCD since this ancillary procedure is not harmless. Patients considered for
prophylactic drain placement are primarily those with occlusion of multiple large vessel branches that
supply the spinal cord, such as the subclavian and bilateral internal iliac arteries, or in cases in which blood
pressure augmentation is considered to be risky, such as symptomatic patients or those with a genetically
triggered aortic disease.

EARLY MORTALITY AND MAJOR ADVERSE EVENTS
The primary objective of aneurysm repair is to prevent aortic-related deaths while avoiding significant
disability. Crucial outcomes include rates of death and disabling events, such as renal function deterioration,
SCI, stroke, myocardial infarction, and respiratory failure. Finally, it is important to evaluate the durability
of the repair by assessing secondary interventions, as well as target vessel outcomes.

A systematic review of the literature published in 2020 comparing open and endovascular TAAA repair
analyzed 71 studies, of which 24 reported outcomes of F/B-EVAR with a total of 2,059 patients and 47
reported results of open TAAA repair encompassing a total of 12,324 patients. The mean age was 72 in the
endovascular group and 63 in the open surgery repair group (P < 0.01). Endovascular patients had more
coronary artery disease (44% vs. 31%; P < 0.01), COPD (35% vs. 31%; P = 0.08), and diabetes (14% vs. 9%; P <
0.01) . Perioperative mortality was similar between the groups, with the pooled analysis showing 9%
[59]
mortality in the open and 7% in the endovascular series, P = 0.21. SCI was more prevalent after
endovascular procedures presenting a 13% rate against 7% with the open approach, P < 0.01. On the other
hand, permanent paraplegia was found to have similar rates (5% vs. 4%, P = 0.39). AKI and posoperative
dialysis were both significantly higher with open repair (22% vs. 12%, P = 0.01) and (12% vs. 6%, P = 0.03),
respectively. Nevertheless, permanent dialysis had similar rates (4% vs. 3%, P = 0.93). Moreover, no
[59]
difference was found in stroke rates (4% vs. 3%, P = 0.06) .

A study in Canada compared open and endovascular repair of TAAA. The study evaluated death,
permanent SCI, permanent dialysis, and stroke in a composite variable termed “thoracoabdominal aortic
aneurysm life-altering events” (TALEs). A total of 664 TAAA repairs were included in the study, of which
303 (45.5%) were endovascular and 361 (54.5%) were open surgery. In-hospital outcomes demonstrated that
open repair was associated with a higher incidence of TALE (26.1% vs. 17.4%, P = 0.02); however, no
[60]
difference was found in the long-term outcomes .

In 2019, Motta et al. published their outcomes of 150 patients treated with F/B-EVAR . PRA and
[61]
paravisceral aneurysms were included in the group of type IV aneurysms based on the frequent necessity of
[61]
incorporation of all four visceral vessels in either type . The early mortality demonstrated by that study
was 2.7%. Major adverse events included respiratory insufficiency in 10 patients (7%), stroke and
myocardial infarction in 0.7% each (1/150), and paraplegia in 2.7% (4 patients). AKI was identified in 4.7%
of patients (7/150), with two patients requiring temporary dialysis .
[61]

More recently, Oderich et al. reported the midterm outcomes of a prospective, nonrandomized study with
430 patients who underwent F/BEVARs, of which 297 had TAAAs and 133 had PRA . The 30-day overall
[62]
mortality was 0.9%; for TAAAs, extent IV was 1.5%, and for extent I to III was 0.6%. The incidence of
paraplegia was significantly higher (P < 0.004) in patients with Extent I-III TAAAs (8%) as compared to
Extent IV or PRAs (2% each), as expected. Among the 17 patients who developed SCI, 7 of them achieved
total or partial recovery and were able to ambulate within one month, whereas 7 patients (4%) treated for
Extent I-III TAAAs suffered from permanent paraplegia. Interestingly, 10 patients with prophylactic spinal
cord drainage (SCD) had paraplegia. Out of 10 patients with prophylactic SCD, 2 patients experienced