A multicenter study of emergency endovascular repair of the thoracic aorta: Indications and outcomes

Abstract

Objective: Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery.

Study design and scope: A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units.

Patients, inclusion criteria: 1) Ruptured descending thoracic aortic aneurysms (RTAA); 2) Blunt traumatic thoracic aortic injury (TAI); and 3) Complicated acute type B aortic dissections (TBADc).

Primary variables: Patient mortality, survival and reoperation rate.

Secondary variables: Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications.

Results: A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the RTAA group (27.9%). The mean actuarial survival rate was 67 ± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%).

Conclusions: Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality - though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.

Keywords: Aneurisma aórtico; Aortic aneurysm; Aortic dissection; Disección aórtica; Emergency endovascular repair; Endograft; Endoprótesis; Enfermedades de aorta torácica; Mortalidad; Mortality; Reparación endovascular urgente; Thoracic aortic disease; Traumatic aortic rupture; Traumatismo aórtico.