Mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR).

Abstract

We evaluated mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR). Between 1996 and 2009, 421 patients underwent TEVAR for the following indications: atherosclerotic aneurysms, type B dissections, penetrating ulcers and traumatic lesions. Twenty-one patients underwent secondary surgical interventions. Indications were type I endoleak formation, retrograde type A dissection, distal aneurysm formation as well as infection. Retrospectively, by analysing referral computed tomography scans and by current knowledge, failure could have been foreseen in 72% of patients. Median interval to secondary surgical intervention was 24 months (IQR 8-40). Sixteen patients underwent thoracic or thoracoabdominal repair and five patients underwent ascending and hemiarch replacement. In-hospital mortality was 19%. Cause of death was multiorgan failure in all cases. The need for secondary surgical intervention after TEVAR is low but carries risk. By analysing mechanisms of failure, the majority of these events could have been avoided by a more strict indication. Thereby, further critical evaluation and respecting limitations of TEVAR will help to reduce the need for these operations.