Journal Article

Long-term results of etiology-based thoracic endovascular aortic repair: a single-center experience

Yoshitake, Akihiro, Nakazawa, Ken, Takazawa, Akitoshi, Kinoshita, Osamu, Asakura, Toshihisa, Nakajima, Hiroyuki

2024

Overview

The use of thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm (TAA) and Stanford type B aortic dissection (TBAD) has been increasing; however, in terms of etiology, the differences of long term after TEVAR outcomes remain unexplored. Thus, we investigated etiology-specific long-term results of TEVAR for TAA and TBAD. A total of 421 TEVAR procedures were performed at our institution from July 2007 to December 2021; 249 TAA cases and 172 TBAD cases were included. Traumatic aortic dissection and aortic injury cases were excluded. The mean observation duration was 5.7 years. The overall 30-day mortality rate was 1.4% ( n  = 6), with 1.2% ( n  = 3) in the TAA group and 1.7% ( n  = 3) in the TBAD group. The overall incidence of postoperative stroke was 0.9% ( n  = 4), with 1.2% ( n  = 3) and 0.6% ( n  = 1) in the TAA and TBAD groups, respectively ( p  = 0.90). Paraplegia developed in 1.7% ( n  = 7) of patients, with 2.4% ( n  = 6) in the TAA group and 0.6% ( n  = 1) in the TBAD group. Freedom from aortic-related death was not significantly different between the two etiologies; however, thoracic reintervention was more common in the TBAD group ( p  = 0.003), with endoleak being the most common indication for reintervention. Additionally, retrograde type A aortic dissection occurred in four TBAD cases, while migration occurred in three TAA cases. The perioperative results of TEVAR for TAA and TBAD were satisfactory. The long-term results were unfavorable owing to the occurrence of etiology-specific and common complications. In terms of the high frequency of reintervention, the long-term complications associated with TEVAR are etiology specific.

• Publisher: Springer Japan,Springer Nature B.V
• Subject: Aged / Aneurysms / Aorta / Aorta, Thoracic - diagnostic imaging / Aorta, Thoracic - surgery / Aortic Aneurysm, Thoracic - diagnosis / Aortic Aneurysm, Thoracic - mortality / Aortic Aneurysm, Thoracic - surgery / Aortic aneurysms / Aortic dissection / Aortic Dissection - mortality / Aortic Dissection - surgery / Biomedical Engineering and Bioengineering / Cardiac Surgery / Cardiology / Cardiovascular disease / Cardiovascular system / Chronic obstructive pulmonary disease / Coronary vessels / Diabetes / Dissection / Embolisms / Endovascular Aneurysm Repair - adverse effects / Endovascular Aneurysm Repair - methods / Etiology / Female / Fistula / Follow-Up Studies / Hospitals / Humans / Incidence / Kidney diseases / Male / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / Mortality / Original / Original Article / Ostomy / Paralysis / Paraplegia / Paraplegics / Patients / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Respiratory failure / Retrospective Studies / Risk Factors / Spinal cord injuries / Stroke / Thorax / Time Factors / Tracheotomy / Treatment Outcome / Vascular Surgery / Vein & artery diseases