Incidence and management of intercostal patch aneurysms after repair of thoracoabdominal aortic aneurysms

Objective

The reimplantation of intercostal arteries during the repair of descending thoracic aortic or thoracoabdominal aortic aneurysms preserves spinal cord perfusion and might reduce the risk of spinal cord ischemic injury. However, the retained cuff of native aortic tissue around the intercostal vessels might become aneurysmal. We reviewed our experience with patients who had intercostal patch aneurysms after descending thoracic aortic and thoracoabdominal aortic aneurysm repair.

Methods

From January 1986 to July 2008, 38 patients with descending thoracic aortic aneurysms and 117 patients with thoracoabdominal aortic aneurysms underwent surgical repair with cardiopulmonary bypass, hypothermic circulatory arrest, and intercostal artery reimplantation as a Carrel patch. Eleven (7.1%) of these 155 patients (2 with descending thoracic aortic aneurysms and 9 with thoracoabdominal aortic aneurysms) developed intercostal patch aneurysms that required surgical treatment. Using either a repeat open operation (n = 8) or endovascular stent graft placement (n = 3), we repaired 11 intercostal patch aneurysms a mean of 5.3 years after the initial repair (range, 0.1–13.7 years). Five of the 11 patients had Marfan syndrome.

Results

There were no in-hospital deaths or reoperations for bleeding, strokes, or spinal cord ischemic injury, and no patient had renal failure requiring dialysis. Two patients had late aortic graft infections. During the follow-up interval that extended to 7.5 years, there were 6 late deaths from 31 to 90 months postoperatively.

Conclusions

Intercostal patch aneurysms are a complication of the sparing of intercostal arteries during thoracic aneurysm repair. They can be safely repaired with either open or endovascular techniques.

CTSNet classification: 18, 33

Abbreviations and Acronyms: CT, computed tomographic, DTAA, descending thoracic aortic aneurysm, SCII, spinal cord ischemic injury, TAAA, thoracoabdominal aortic aneurysm