Impact of Aortic Morphology on Long-Term Outcomes After TEVAR for Descending Thoracic Aortic Aneurysm: A Nationwide Registry Study.

Abstract

This study aimed to identify anatomical factors associated with long-term outcomes after thoracic endovascular aortic repair (TEVAR) for degenerative descending thoracic aortic aneurysm (DTAA) using a nationwide registry in Japan. From 2008 to 2015, 23,303 TEVAR cases were prospectively collected by the Japanese Committee for Stentgraft Management (JACSM). Of these, 10,293 patients who underwent initial TEVAR for degenerative DTAA after excluding 353 early deaths were enrolled. Cox regression analysis was performed to determine factors associated with aneurysm-related death and reintervention. Adjusted restricted cubic splines (RCS) were applied to examine potential nonlinear relationships between significant anatomical factors and outcomes. The mean age was 74±8 years, and 7,748 patients (75%) were male. Ten-year freedom from aneurysm-related death and reintervention was 75.5% and 88.4%, respectively. On multivariate analysis, aneurysm diameter, distal neck diameter, and predischarge endoleak were associated with aneurysm-related death. For reintervention, aneurysm diameter, proximal and distal neck diameters, zone 2 landing, and predischarge endoleak were significant predictors. RCS analysis for reintervention showed that increasing aneurysm diameter was associated with higher hazard ratios, reaching 2.21 (95% CI, 1.73-2.83) at 75 mm using 50 mm as reference. For proximal neck diameter, the hazard ratio increased to 1.59 (95% CI, 1.30-1.96) at 35 mm compared with 30 mm. For distal neck diameter, the hazard ratio reached 1.22 (95% CI, 0.96-1.53) at 35 mm compared with 30 mm. The JACSM registry demonstrated that preoperative aneurysm diameter and neck diameters were associated with long-term outcomes after TEVAR for DTAA.