Endovascular repair for diverse pathologies of the thoracic aorta: an initial decade of experience.

Abstract

BACKGROUND:

Endovascular grafts have rapidly evolved as a minimally invasive treatment for a variety of acute and chronic disorders of the thoracic aorta. Application of this technology at a single center is reported.

STUDY DESIGN:

Between 1998 and 2007, 197 patients underwent thoracic endovascular aortic repair. Primary indications included degenerative aneurysms (n = 121), type B aortic dissection (n = 44), mycotic aneurysms (n = 9), traumatic disruptions (n = 9), intramural hematoma (n = 5), pseudoaneurysm (n = 4), and miscellaneous pathology (n = 5). An analysis of patient demographics, periprocedural records, complications, reinterventions, and survival was conducted.

RESULTS:

Thirty-day mortality was 6%, which was lowest among patients undergoing treatment for a degenerative thoracic aortic aneurysm (2.4%, 3 of 121). Major adverse events included stroke in 3%, spinal cord ischemia in 2%, peripheral vascular repair in 4.5%, renal failure in 4.5%, and open conversion in one patient (0.5%). Both preoperative serum creatinine (odds ratio 1.44, 95% CI 1.02 to 2.04, p = 0.039) and number of endograft components (odds ratio 1.43, 95% CI 1.01 to 2.01, p = 0.043) were predictors of major adverse events. Kaplan-Meier analysis revealed a reduction in late survival among patients with preoperative creatinine >or=1.8 mg/dL (p < 0.001). One- and 5-year intervention-free survivals were 77%+/-3% and 41%+/-6%, respectively.

CONCLUSIONS:

Thoracic endovascular aortic repair represents an effective treatment for a variety of pathologic states. But the risk-benefit analysis for thoracic endovascular aortic repair should carefully consider the extent of disease, pathologic condition, and renal function.

• Authors: Elliot L Chaikof, Christopher Mutrie, Karthik Kasirajan, Ross Milner, Edward P Chen, Ravi K Veeraswamy, Thomas F Dodson, Atef A Salam
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 208 Issue 5 Pg. 802-16; discussion 816-8 (May 2009) ISSN: 1879-1190 [Electronic] United States
• PMID: 19476841 (Publication Type: Journal Article)

Chemical References

• Creatinine

Topics

• Aged
• Aged, 80 and over
• Aortic Dissection (surgery)
• Aortic Aneurysm, Thoracic (mortality, pathology, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects)
• Cause of Death
• Creatinine (blood)
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Prosthesis Failure
• Risk Assessment
• Stroke (epidemiology)