Pathology-specific late outcome after endovascular repair of thoracic aorta: a single-centre experience

Abstract

Objectives: Endovascular treatment of thoracic aortic lesions appears to be advantageous. However, long-term outcomes remain poorly reported. This retrospective study reported 6-year outcomes of thoracic endovascular aortic repair.

Methods: A total of 74 patients underwent endovascular thoracic aorta treatments between 1999 and 2007; 13 had thoracic aortic dissections, 19 had traumatic aortic injuries, 35 had aneurysms, 6 had pseudoaneurysms and 1 had a penetrating ulcer. The mean follow-up was 66 months after 30 perioperative days. Yearly follow-ups included computed tomography angiography or magnetic resonance angiography. Patient demographics, mortality, complications and reinterventions were analysed.

Results: The early 30-day mortality and the overall late mortality were 9.5 (7/74) and 37.8% (28/74), respectively. Late mortality was higher in patients with aneurysms than in the other groups (20/35; 57% vs 8/39; 20.5%; P = 0.002). Aortic-related mortality occurred in 5/35 (14%) patients with aneurysms, but not in other groups (P = 0.02). No relationships among late complications were found for traumatic aortic injuries. The most common complication was an endoleak (21/74, 28.4%), which occurred more frequently with aneurysms than other disorders (18/35, 51.4% vs 3/39, 7.7%; P < 0.001). Endoleaks also occurred most frequently in aortic-related deaths (16/69 vs 5/5; P = 0.001). Type 1 endoleaks occurred significantly more often with aneurysms (13/35) than with other disorders (P = 0.004). Reintervention was required in 9 patients (12%); 8 with atherosclerotic aneurysms (8/35; 23%). A false lumen was thrombosed in 54% of dissections (7/13), and shrank in 39% (5/13).

Conclusions: Long-term outcomes depended on aortic pathology. Aortic aneurysms were the most complicated and caused the highest mortality, probably due to atherosclerotic disease evolution. Patients with traumatic aortic injuries appeared to have the best long-term outcomes.

Keywords: Endoleak; Endovascular repair; Thoracic aorta.