Simultaneous Endovascular Repair Is Not Associated With Increased Risk for Thoracic and Abdominal Aortic Pathologies: Early and Midterm Outcomes

Weichang Zhang; Lei Zhang; Xin Li; Ming Li; Jian Qiu; Mo Wang; Chang Shu

doi:10.3389/fcvm.2022.883708

Simultaneous Endovascular Repair Is Not Associated With Increased Risk for Thoracic and Abdominal Aortic Pathologies: Early and Midterm Outcomes

Front Cardiovasc Med. 2022 May 27:9:883708. doi: 10.3389/fcvm.2022.883708. eCollection 2022.

Authors

Weichang Zhang^{1

2}, Lei Zhang^{1

2}, Xin Li^{1

2}, Ming Li^{1

2}, Jian Qiu^{1

2}, Mo Wang^{1

2}, Chang Shu^{1

2

3}

Affiliations

¹ Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
² Institute of Vascular Diseases, Central South University, Changsha, China.
³ Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China.

Abstract

Coexisting multilevel aortic pathologies were caused by atherosclerosis and hypertension and presented in a small subgroup of patients. Endovascular repair is a safe and effective treatment for a variety of aortic pathologies. However, fewer small series and cases were reported using simultaneous thoracic endovascular repair (TEVAR) and endovascular aneurysm repair (EVAR) for both aortic segments. To determine the outcomes of simultaneous and separately TEVAR and EVAR treating for multilevel aortic pathologies. Between 2010 and 2020, 31 patients and 22 patients were treated by one-staged and two-staged repair, respectively at a single center. All patients had the concomitant thoracic and abdominal aortic disease (aortic dissection, aneurysms, and penetrating aortic ulcers). Compared with the patients with two-staged aortic repair, the one-staged repair patients were older (mean age, 68 vs. 57 years; P < 0.001) and had a larger preoperative maximal aortic diameter (67.03 ± 10.65 vs. 57.45 ± 10.36 mm; p = 0.002). The intraoperative and postoperative outcomes show that the procedure times and length of hospital stay (LOS) were longer in the two-staged group. There is no significant difference in postoperative complications between the two groups. In the follow up, the freedom from re-intervention and the mean survival rate for the one-staged group were 100 vs. 100%, 92.4 vs. 95%, and 88 vs. 88% at one, two, and 5 years, respectively, whereas the mean survival rate for the two-staged group was 86.4 vs. 90.5%, 87 vs. 90.5%, and 76 vs. 84% at one, two, and 5 years, respectively, all with no statistical difference. Combined TEVAR and EVAR can be performed successfully with minimal morbidity and mortality. The one-staged repair was not associated with the increased risk for multilevel aortic pathologies treatment.

Keywords: EVAR; abdominal aortic aneurysm (AAA); aortic pathologies; simultaneous; spinal cord injury (SCI); thoracic endovascular aortic repair (TEVAR).