gms | German Medical Science

125. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

22. - 25.04.2008, Berlin

Risk–stratification with the EuroSCORE in Hybrid-Procedures of Thoracoabdominal Aortic Aneurysms

Meeting Abstract

  • corresponding author M. Gawenda - Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln, Köln, Deutschland
  • M. Aleksic - Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln, Köln, Deutschland
  • V. Reichert - Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln, Köln, Deutschland
  • G. Wassmer - Institut für Medizinische Statistik und Epidemiologie; Klinikum der Universität zu Köln, Köln, Deutschland
  • J. Brunkwall - Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln, Köln, Deutschland

Deutsche Gesellschaft für Chirurgie. 125. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 22.-25.04.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08dgch8837

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgch2008/08dgch007.shtml

Veröffentlicht: 16. April 2008

© 2008 Gawenda et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: The hybrid procedure as a combined endovascular and open approach with retrograde revascularisation of the visceral and renal vessels has been realized in order to minimize peri-operative complications in thoracoabdominal aortic aneurysm (TAAA) repair. To make the results of this new approach comparable to the results of traditional open repair, risk stratification schemes could be applied. The aim of the study was to evaluate risk–stratification scheme of the additive and logistic EuroSCORE in patients undergoing hybrid procedures.

Materials and methods: Within an experience of 350 aortic stent-grafts (1998 - August 2007), 22 of the patients (16 men)(age in median 64 years, min- max 35– 78) with TAAA (Crawford type I, II, III, and V) were treated with a hybrid procedure. The procedures were electively conducted in 17 patients; five patients demonstrated contained ruptures of the TAAA. The revascularization of the renals, the superior mesenteric artery, and the celiac trunk was accomplished via transperitoneal bypass grafting using the infrarenal aorta or the iliacs as donor vessel. The aneurysm (75 [70 – 100 mm] mm) was subsequently excluded by stent-graft deployment, in twelve cases as two stage procedures In all patients risk stratification was performed due to the European System for Cardiac Operative Risk Evaluation (EuroScore), a method of calculating predicted operative mortality for patients undergoing cardiac surgery.

Results: The entire procedure was technically successful in 21 patients. One man suffered bowel ischemia due to mesenteric bypass occlusion followed by multi-organ failure leading to death (2nd day) before the planned endovascular procedure. The median operative time of the successful procedures was 360 (330-455) minutes. Five patients suffered from multi-organ failure leading to death at the 20 (16-42) post-operative days. All other patients were transferred from the ICU to the ward at the 4 (1-51) days. Artificial ventilatory support was necessitated in 325.5 (0-2057) hours. The survivors were discharged 21 (5-47) days in median after the operation, while the postoperative studies revealed the patency of the vessels and no evidence of type I endoleak. During the follow up (1-30 months) spiral-CT scanning revealed distinct shrinkage of the aneurysm, no graft migration or endoleak and patency of all revascularised vessels, except for one renal artery in three patients. No survivor experienced any temporary or permanent neurological deficit.Overall, additive EuroScore was 7.7 (mean; range, 3 – 13) and logistic EuroScore was 15.1 (mean; range, 3-46).The additive EuroSCORE as well as the logistic EuroSCORE discriminated significantly (one way ANOVA) between the survival group and the lethal group (additive EuroScore: 6.8 [3-13] vs. 10.0 [7-13]; logistic EuroSCORE: 11.7 [2.8-45.6] vs. 24.2 [9.9-40.0]).

Conclusion: The combined endovascular and open surgical approach is feasible, without cross-clamping of the aorta and with minimized ischemia time for renal and visceral arteries. It seems to be a suitable strategy even for high-risk patients with a thoraco-abdominal aortic aneurysm, but the long term durability has to be proven. The EuroSCORE seems to be a good and reliable risk-stratification score in hybrid procedures. To compare the hybrid procedure with traditional open repair, forthcomming comparative studies should evaluate their cohorts by means of the EuroSCORE.