Paravisceral Transaortic Endarterectomy: A Case Series At A Quaternary Care Center

Document Type

Conference Proceeding

Publication Date

3-1-2025

Publication Title

Ann Vasc Surg

Keywords

acute kidney failure, aged, bleeding, case study, Caucasian, clinical article, complication, conference abstract, diagnosis, drug therapy, endarterectomy, female, follow up, gastrointestinal hemorrhage, hospital readmission, human, hyperlipidemia, hypertension, length of stay, male, middle aged, morbidity, mortality, operating room, pneumonia, postoperative complication, retroperitoneal hematoma, retrospective study, risk factor, special situation for pharmacovigilance, surgery, tobacco use

Abstract

Introduction and Objectives: Occlusive disease of the paravisceral aorta poses a challenge for an endovascular approach. We sought to evaluate the outcomes of paravisceral transaortic endarterectomy (PTE) at our quaternary care center. Methods: A retrospective analysis was performed of patients who underwent PTE between 2006 and 2024. Results: 14 patients were identified. The majority of our patients were of white race, non-Hispanic, and of female sex with a mean age of 66 years. Risk factors included active tobacco use, hypertension and hyperlipidemia in 50%, 79% and 79% of patients, respectively. Indications/Operations performed are listed in Table 1. Intraoperative duplex was performed in five patients, with re-intervention in three patients for retained distal plaque/raised endpoint. Supraceliac clamping was performed in 13 (93%) with a mean clamp time of 34.5 min. Mean operating room (OR) time and estimated blood loss was 470 min and 1100 mL, respectively. Postoperative complications included: pneumonia (29%), acute kidney injury (29%), and gastrointestinal bleeding (7%). One patient returned to the OR for a retroperitoneal hematoma. Mean hospital length of stay was 18.3 days. No mortalities were present at 30 days. One patient required readmission within 30 days and two patients required re-intervention at six and nine months. Mean follow-up was 28 months (1-84 months) with 11/14 (79%) alive without recurrent symptoms. Figure 1 illustrating before and after (4 years) PTE for CMI. Conclusions: PTE for occlusive disease of the paravisceral aorta is an option with acceptable mortality, morbidity, and re-intervention rates. Intraoperative duplex may help ensure a good technical outcome. [Formula presented] [Formula presented]

Volume

112

First Page

407

Last Page

408

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