Endovascular Repair of Penetrating Thoracic Aortic Ulcers Using Tubular Stent Grafts Versus Stent Grafts With a Proximal Scallop

Alexander Kupferthaler; Sven R Hauck; Michael Schwarz; Maximilian Kern; Julia Deinsberger; Theresa-Marie Dachs; Christoph Neumayer; Maria-Elisabeth Stelzmüller; Marek Ehrlich; Christian Loewe; Martin A Funovics

doi:10.1177/15266028221149919

Endovascular Repair of Penetrating Thoracic Aortic Ulcers Using Tubular Stent Grafts Versus Stent Grafts With a Proximal Scallop

J Endovasc Ther. 2023 Jan 20:15266028221149919. doi: 10.1177/15266028221149919. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
² Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria.
³ Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
⁴ Institute of Medical Radiology, Diagnostic, Intervention, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria.
⁵ Department of Radiology, Klinik Floridsdorf, Vienna, Austria.
⁶ Department of Dermatology, Medical University of Vienna, Vienna, Austria.
⁷ Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
⁸ Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
⁹ Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

PMID: 36680393
DOI: 10.1177/15266028221149919

Abstract

Purpose: In penetrating aortic ulcers (PAUs), limited data support tubular thoracic endovascular aortic repair (TEVAR) as a viable treatment option. For treatment of more proximal PAUs, hybrid approaches and-more recently-scalloped TEVAR (scTEVAR) have been advocated. Outcomes of scTEVAR specifically for PAUs have not yet been reported. This study reports long-term outcomes for tubular and scTEVAR in PAUs and compares the safety profile in both cohorts regarding the significantly more proximal landing zone (LZ) for scTEVAR.

Materials and methods: This single-center retrospective cohort study includes all nonacute patients treated for complicated PAU with scTEVAR and tubular TEVAR. Patient and PAU characteristics as well as procedural success, complication and reintervention rates, and all-cause and aortic mortality were analyzed.

Results: Of 212 TEVAR procedures reviewed, 21 patients with tubular TEVAR and 19 patients with scTEVAR were included. Patient and PAU characteristics were similar, and LZ was significantly more proximal in the scTEVAR cohort (p=0.0001), with similar number and types of supra-aortic revascularization procedures. Clinical success was reached in all 40 patients (100%), and reintervention rate was 2/21 (9.5%) and 1/19 (5.3%), respectively. Over the mean follow-up of 63 (TEVAR) and 53 (scTEVAR) months, clinical success was stable in all patients with one (abdominal) aortic-related mortality in the scTEVAR cohort.

Conclusion: Treatment of complicated PAUs with TEVAR as well as scTEVAR provides excellent and similar clinical success, stability of clinical success, and aortic survival with acceptable complication and reintervention rates. Scalloped TEVAR safely lengthens the proximal sealing zone to address more proximal pathologies.

Clinical impact: Treatment of asymptomatic complicated penetrating aortic ulcers (PAUs) with thoracic endovascular aortic repair (TEVAR) provides excellent clinical success and acceptable complication and reintervention rates. More patients become amenable to endovascular treatment by including scalloped TEVAR (scTEVAR) as a means to safely lengthen the proximal sealing zone to address more proximal pathologies.

Keywords: aortic arch; penetrating aortic ulcer; scallop; stent graft; thoracic endovascular aortic repair.