Abstract
Objective
Thoracic endovascular aortic repair (TEVAR) has become a standard treatment for acute
and chronic thoracic aorta diseases. We analysed long-term outcomes and risk factors
of TEVAR procedures according to the aortic pathology.
Methods
Demographics, indications, technical details, and outcomes of patients undergoing
TEVAR procedures in our institutions were prospectively collected and retrospectively
analyzed. Overall survival was determined using Kaplan-Meier methods while Log-rank
tests were used to compare the survival between groups. Cox regression analysis was
used to identify risk factors.
Results
Between June 2002 and April 2020, 116 patients underwent TEVAR for different thoracic
aorta diseases. Among them, 47 patients (41%) underwent TEVAR for aneurysmatic aortic
disease, 26 (22%) for type-B aortic dissection, 23 (20%) for penetrating aortic ulcer,
11 (9%) after previous type-A dissection treatment and 9 (8%) for traumatic aortic
injury. Patients with post-traumatic aortic injury were younger (p<0.01), with less
hypertension (p<0.01), diabetes (p<0.01) and prior cardiac surgery (p<0.01). Survival
was different based on indication for TEVAR (log rank 0.024). Patients after previous
type-A dissection treatment had the worst survival rate (50% at 5 years) while survival
for aneurysmatic aortic disease was 55% at 5 years. No late death occurred in the
traumatic group. Cox-regression model identified independent predictors for mortality:
age (HR 1.05, 95% CI 1.01-1.09, p= 0.006), male gender (HR 3.2, 95% CI 1.1-9.2, p=0.028),
moderate COPD (HR 2.1, 95% CI 1.02-4.55, p=0.043), previous cardiac surgery (HR 2.1,
95% CI 1.008-4.5, p=0.048), and treatment indication for aneurysm (HR 2.6, 95% CI
1.2-5.2, p=0.008).
Conclusions
TEVAR is a safe and effective procedure with excellent long-term results in case of
traumatic aortic injury. The overall long-term survival is affected by aortic pathology,
associated comorbidities, gender and previous cardiac surgery.
KEYWORDS
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Article info
Publication history
Accepted:
February 8,
2023
Received in revised form:
February 6,
2023
Received:
October 25,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
