Outcome of thoracic endovascular aortic repair in patients with thoracic and thoracoabdominal aortic aneurysms.

Abstract

This study reports the long-term results after thoracic endovascular aortic repair (TEVAR) in thoracic aortic aneurysms (TAAs) and thoracoabdominal aortic aneurysms (TAAAs). Between 1997 and 2010, 269 patients were treated with TEVAR, 100 of them (72 male; mean age, 68.3 years) for aneurysmal disease. An intact TAA (iTAA) was present in 49 patients and an intact TAAA (iTAAA) in 18. In 25 patients, there was a ruptured TAA or ruptured TAAA (rTAA). Eight patients were admitted with a post-traumatic TAA (pTAA). Retrospective analysis was performed from a prospectively maintained database. Primary end points were 5-year all-cause and TEVAR-related mortality. Secondary end points were causes of death, complications, and reinterventions (RIs). A 5-year follow-up was complete in all cases. The overall 5-year mortality rate was 50% (40.8% in iTAA, 80% in rTAA, 12.5% in pTAA, and 50% in iTAAA, respectively; log-rank test, P = .00012). The overall procedure-related mortality was 21% (10.2% [n = 5] in iTAA, 40% [n = 10] in rTAA, 33% [n = 6] in iTAAA, and 0 in pTAA, respectively; log-rank test, P = .00013). Freedom from complication was 52%, 47.2%, and 47.2% at 1, 3, and 5 years, respectively. There were a total of 30 RIs in 25 patients. Freedom from RI was 82%, 77.8%, and 71.2% at 1, 3, and 5 years. Stepwise forward logistic regression analysis revealed rTAA and occurrence of complications were risk factors for survival (odds ratios, 7.7 and 4.2, respectively). Long-term results after TEVAR for aneurysmatic aortic disease demonstrate considerable overall and procedure-related mortality in both elective and urgent indications. Complications and RIs occur still as late events and emphasize the necessity for long-term follow-up.