Single-Center Retrospective Subgroup Analysis of "Primary Aortic" (Aneurysm, Aortic Dissection, PAU) and "Secondary Aortic" (Iatrogenic, Trauma, Aortoesophageal Fistula) Indications for Emergency TEVAR

Artur Rebelo; Jumber Partsakhashvili; Ulrich Ronellenfitsch; Endres John; Jörg Kleeff; Jörg Ukkat

doi:10.3390/jcm12124037

Single-Center Retrospective Subgroup Analysis of "Primary Aortic" (Aneurysm, Aortic Dissection, PAU) and "Secondary Aortic" (Iatrogenic, Trauma, Aortoesophageal Fistula) Indications for Emergency TEVAR

J Clin Med. 2023 Jun 13;12(12):4037. doi: 10.3390/jcm12124037.

Authors

Artur Rebelo¹, Jumber Partsakhashvili¹, Ulrich Ronellenfitsch¹, Endres John¹, Jörg Kleeff¹, Jörg Ukkat¹

Affiliation

¹ Department of General, Abdominal, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany.

Abstract

Background: The aim of this study was to analyze the outcome of emergency thoracic endovascular aortic repair (TEVAR) in the treatment of "primary aortic" (aneurysm, aortic dissection, penetrating aortic ulcer (PAU)) and "secondary aortic" (iatrogenic, trauma, and aortoesophageal fistula) pathologies.

Methods: Retrospective review of a cohort of patients treated at a single tertiary referral center from 2015 to 2021. The primary end point was postoperative in-hospital mortality. Secondary end points were the duration of the procedure, duration of postoperative intensive care treatment, length of hospital stay, and the nature and severity of postoperative complications according to the Dindo-Clavien classification.

Results: A total of 34 patients underwent TEVAR for emergency indications. Twenty-two patients were treated for primary and twelve patients for secondary aortic pathologies. Concerning in-hospital mortality, no statistically significant difference could be observed between the primary and secondary aortic groups (27.3% vs. 33.3%, p = 0.711). Patients with an aortoesophageal fistula had a mortality rate of 66.7%. Postoperative morbidity (Dindo-Clavien > 3) was also not statistically significantly different between the primary and secondary aortic groups (36.4% vs. 33.3%, p = 0.86). Preoperative hemoglobin level (p < 0.001 for mortality, p = 0.002 for morbidity), hemoglobin level difference (p = 0.022, p = 0.032), postoperative creatinine level (p = 0.009, p = 0.035), and pre- and postoperative lactate levels (p < 0.001 for both mortality and morbidity) were found to be independent factors associated with postoperative mortality and morbidity (Dindo-Clavien > 3), respectively. The preoperative creatinine level was found to be associated with mortality (p = 0.024) but not morbidity.

Conclusions: Morbidity and in-hospital mortality are still considerable after emergency TEVAR for both primary and secondary aortic indications. Pre- and postoperative levels of hemoglobin, creatinine, and lactate may be valuable to predict patient outcomes.

Keywords: TEVAR; aortic aneurysm; aortic dissection; aortic emergencies; aortoesophageal fistula; iatrogenic; trauma.

Grants and funding

This work was partially supported by the Advanced Clinician Scientist Program of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. The content is solely the responsibility of the authors and does not represent the official views of the funding agencies. We also acknowledge the financial support of the Open Access Publication Fund of the Martin-Luther-University Halle-Wittenberg.