VESS23 - A Comparison of Thoracoabdominal Aortic Aneurysms Open Repair in Patients with or without “Shaggy Aorta”

Objectives: Shaggy aorta (SA) syndrome is an independent risk factor for mortality, spinal cord ischemia, and acute renal failure in patients submitted to open thoracoabdominal aortic aneurysm (TAAA) repair. The aim of this paper is to report the results of a single-center large cohort of patients treated with open surgical repair (OSR) for TAAA with SA, comparing the outcomes with patients affected by TAAA without SA, and analyzing the impact of the actual scores for SA on the outcomes.

Methods: All consecutive patients receiving OSR for TAAA between 2012 and 2021 were retrospectively analyzed. Clinical data from patients with degenerative TAAA were included and analyzed for preoperative characteristics and postoperative outcomes; patients with ruptured TAAA, and patients with aortic dissection were excluded from the analysis. Patients with degenerative aortic aneurysm, thrombus measurement in non-aneurysmal aortic segments (≤40mm), atheroma thickness ≥ 5mm, and finger-like thrombus projection were included in the “SA group”, while the others were included in the “non-shaggy aorta group” (NSA group). SA group and NSA group were compared using a propensity-matched comparison. Preoperative CT-scans of patients in the SA group were also classified according to the actual SA grading scores.

Results: A total of 58 patients with SA were identified [male 43 (74.1%), mean age 70.1 ± 7.8 years-old]. After propensity matching, there were 48 patients in the SA-group and 48 in the NSA-group with correction of all differences in baseline characteristics. Patients in the SA group presented significantly higher in-hospital mortality (SA group: 10.4% vs NSA group: 2.1%: p <.001), postoperative acute renal failure (RIFLE 4-5) (SA group: 16.7% vs NSA group: 0%: p .002), and embolization-rate (SA group: 25.0% vs NSA group: 8.3%: p .02). Spinal cord ischemia, and stroke rate were not significantly influenced by the presence of SA. In the SA group, 16 (27.6%) patients with end-organ embolization were compared with 42 (72.4%) patients without a documented embolization considering the grade of aortic “shagginess” and no significant difference was identified (p. 0546).

Conclusions: Despite several intraoperative adjuncts, TAAA patients with SA treated with OSR still have worse postoperative outcomes if compared with “non-shaggy” patients. The presence of SA is a risk factor itself, while the grade of “shagginess” seems not to impact on postoperative outcomes.