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.
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.
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).
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Annals of Vascular Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population.Circulation. 2011; 124: 2661-2669
- Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results.J Vasc Surg. 2008; 47: 1094-1098
- Thoracic aorta emergencies: is the endovascular treatment the new gold standard?.Interact Cardiovasc Thorac Surg. 2006; 5: 730-734
- Observations on the failure of stent-grafts in the aortic arch.Eur J Vasc Endovasc Surg. 2007; 34: 451-456
- Pathology-specific secondary aortic interventions after thoracic endovascular aortic repair.J Vasc Surg. 2014; 59: 599-607
- Reporting standards for thoracic endovascular aortic repair (TEVAR).J Vasc Surg. 2010; 52 (33 e15): 1022-1033
- Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database.Circulation. 2013; 127: 24-32
- Late outcomes of a single-center experience of 400 consecutive thoracic endovascular aortic repairs.Circulation. 2011; 123: 2938-2945
- Risk factors for early and late mortality after thoracic endovascular aortic repair.J Thorac Cardiovasc Surg. 2008 May; 135 (1109.e1-1109): 1103-1109
- Risk factors for late mortality after endovascular repair of the thoracic aorta.J Vasc Surg. 2010 Sep; 52: 549-554
- Improved Remodeling With TEVAR and Distal Bare-Metal Stent in Acute Complicated Type B Dissection.Ann Thorac Surg. 2020; 110: 1572-1579
- Pathology-specific late outcome after endovascular repair of thoracic aorta: a single-centre experience.Eur J Cardiothorac Surg. 2015 Dec; 48: 923-930
- Endovascular Treatment of Descending Thoracic Aortic Pathology: Results of the Regis-TEVAR Study.Ann Vasc Surg. 2020 Aug; 67: 306-315
- Stent-assisted balloon-induced intimal disruption and relamination of distal remaining aortic dissection after acute DeBakey type I repair.J Thorac Cardiovasc Surg. 2019 Jun; 157 (Epub 2018 Oct 17. PMID: 30501951): 2159-2165https://doi.org/10.1016/j.jtcvs.2018.10.031
- Midterm survival after thoracic endovascular aortic repair in more than 10,000 Medicare patients.J Thorac Cardiovasc Surg. 2015 Mar; 149: 808-820
- Thoracic Endovascular Repair of Complicated Penetrating Aortic Ulcer: An 11-Year Single-Center Experience.J Endovasc Ther. 2016 Feb; 23: 150-159
Accepted: February 8, 2023
Received in revised form: February 6, 2023
Received: October 25, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Elsevier Inc. All rights reserved.