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• W3011493039 abstract "Rocha et al1Rocha R.V. Lindsay T.F. Friedrich J.O. Shan S. Sinha S. Yanagawa B. et al.Systematic review of contemporary outcomes of endovascular and open thoracoabdominal aortic aneurysm repair.J Vasc Surg. 2020; 71: 1396-1412Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar present the most comprehensive—to date—comparative analysis on outcomes after open vs endovascular repair for thoracoabdominal aortic aneurysms (TAAAs). Their analysis is as thorough as it is thoughtful and candid. An important finding of this study relates to the realization that the risk of postoperative complications is high regardless of treatment strategy. Mortality was similar for both treatment modalities, and although one could argue that sicker patients were preferentially treated with endovascular means, clearly the three- to five-fold improvement in early postoperative mortality that is seen when endovascular techniques2Lederle F.A. Freischlag J.A. Kyriakides T.C. Padberg Jr., F.T. Matsumura J.S. Kohler T.R. et al.Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial.JAMA. 2009; 302: 1535-1542Crossref PubMed Scopus (806) Google Scholar, 3Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial.Lancet. 2005; 365: 2179-2186Abstract Full Text Full Text PDF PubMed Scopus (1287) Google Scholar, 4Greenhalgh R.M. Brown L.C. Kwong G.P. Powell J.T. Thompson S.G. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial.Lancet. 2004; 364: 843-848Abstract Full Text Full Text PDF PubMed Scopus (1566) Google Scholar are used for infrarenal abdominal aortic aneurysm will be difficult to replicate in the foreseeable future. The nature of complications is different, but it currently seems that choice of the procedure may simply substitute one set of complications for another. There is a word of caution from the authors, however. Data synthesis was problematic owing to heterogeneity in outcome definitions and lack of standardization on follow-up procedures, an issue further complicated by a lack of contemporary comparisons, and the paucity of information relevant to the extent of the aneurysm repair. The clinical significance of this limitation cannot be overemphasized. Reporting standards initiatives are underway, however, and they will likely address some of those limitations in the future. Fenestrated endovascular aneurysm repair has offered the promise of a minimally invasive alternative to the maximally invasive open TAAA repair. As such, it has the potential to lead to superior outcomes. Has this promise been materialized? As the authors intimated, to answer this question we need one thing, albeit an important one. Clean data. Patient-level data from open and endovascular TAAA repairs that have been performed within the same chronological time frame. This information should be prospectively collected from multiple centers, objectively adjudicated using widely adopted, standardized definitions, and thoughtfully analyzed using validated risk-adjusted statistical methodologies. In addition to assessing early postoperative outcomes, the long-term durability of the endovascular repair, and how this compares to the performance of the open approach5Coselli J.S. LeMaire S.A. Preventza O. de la Cruz K.I. Cooley D.A. Price M.D. et al.Outcomes of 3309 thoracoabdominal aortic aneurysm repairs.J Thorac Cardiovasc Surg. 2016; 151: 1323-1337Abstract Full Text Full Text PDF PubMed Scopus (296) Google Scholar should also be examined carefully. Although in expert hands6Oderich G.S. Ribeiro M. Reis de Souza L. Hofer J. Wigham J. Cha S. Endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched endografts.J Thorac Cardiovasc Surg. 2017; 153: S32-S41 e7Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar,7Mastracci T.M. Greenberg R.K. Eagleton M.J. Hernandez A.V. Durability of branches in branched and fenestrated endografts.J Vasc Surg. 2013; 57 (discussion: 933): 926-933Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar long-term branch instability seems to be uncommon, its ramifications for aneurysm growth and patient survival should not be underestimated. In fact, recently surfaced debates8Mastracci T.M. Modarai B. Tyrrell M. Adam D.J. The proposed UK abdominal aortic aneurysm guidelines: A much needed wakeup call.J Vasc Surg. 2019; 69: 1-3Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,9Katsanos K. Spiliopoulos S. Kitrou P. Krokidis M. Karnabatidis D. Risk of death following application of paclitaxel-coated balloons and stents in the femoropopliteal artery of the leg: a systematic review and meta-analysis of randomized controlled trials.J Am Heart Assoc. 2018; 7: e011245Crossref PubMed Scopus (516) Google Scholar on the long-term benefits of highly promising endovascular technologies make this issue of lasting performance more timely than ever. Last, but not least, such a prospective data collection and analysis should be directed toward understanding the role of patient preferences and regional expertise on outcomes. As device designs mature and familiarity with fenestrated endovascular techniques spreads rapidly from a few centers of excellence to various academic and private practice settings, ensuring quality becomes of paramount importance. Comparative, prospectively analyzed outcomes should serve a critical role in establishing benchmarks against which individual operator and center performance can be assessed. TAAA repair is complex. The time is now for a well thought-out, prospective study to compare the open vs endovascular treatment modalities. Such an endeavor will assist the multiple stakeholders in their decision making and will set the stage for the delivery of high-quality care to optimize short- and long-term outcomes. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Systematic review of contemporary outcomes of endovascular and open thoracoabdominal aortic aneurysm repairJournal of Vascular SurgeryVol. 71Issue 4PreviewThe purpose of the study was to provide a systematic review of the literature reporting the contemporary early outcomes after endovascular and open repair of thoracoabdominal aortic aneurysms (TAAAs). Full-Text PDF" @default.
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• W3011493039 title "Delivering the promise of a minimally invasive thoracoabdominal aneurysm repair: The road less travelled" @default.
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