Surgical strategy for inflammatory thoracic aortic aneurysms in the endovascular surgery era.

Abstract Objective Inflammatory thoracic aortic aneurysms (TAAs) are very rare aortic conditions. Resection and replacement of the inflammatory aorta is the first-line treatment, and thoracic endovascular aortic repair (TEVAR) is recently expected to be a less invasive alternative even in this aortic cohort. In this study, we reviewed our experience with inflammatory TAAs and assessed the preoperative management, surgical procedures, and outcomes. Methods From 2006 to 2019, 21 surgeries were performed for inflammatory TAAs in 17 (only 0.7%) out of 2,583 patient who underwent cardiovascular surgery at our institution. The etiologies were Takayasu’s arteritis in 13 patients, giant cell arteritis in 2, anti-neutrophil cytoplasmic antibody-associated vasculitis in 1, and unknown etiology in 1. The mean follow-up period was 66.2±50.2 (range: 19–186) months. Results Three patients underwent multiple surgeries. The aorta was replaced in 14 patients (ascending aorta: 9, aortic arch: 4, and thoracoabdominal aorta: 1). Three isolated TEVAR were performed in two patients and one-stage hybrid aortic repair (ascending aorta and partial arch replacement combined with Zone 0 TEVAR) in four for extended arch and descending thoracic aortic aneurysms. Stent grafts were deployed on the native aorta in five of seven TEVARs. The perioperative inflammation was well-controlled with prednisolone (mean dose: 7.4±9.4 mg) in all patients except one who required two surgeries under inflammation-uncontrolled situations. There were no aorta-related complications, including anastomotic aneurysms and TEVAR-related aortic dissection, during the follow-up period, and the five-year freedom from all-cause death was 92.9%. Conclusions The mid-term outcomes of surgical treatment for inflammatory TAAs were acceptable. Although replacement remains the standard procedure for inflammatory TAAs, TEVAR is a less invasive acceptable alternative when the inflammation is properly managed.