Secondary interventions after elective thoracic endovascular aortic repair for degenerative aneurysms. J Vasc Surg 2013 May;57(5):1269-74
Date
01/29/2013Pubmed ID
23352360DOI
10.1016/j.jvs.2012.10.124Scopus ID
2-s2.0-84876418438 (requires institutional sign-in at Scopus site) 32 CitationsAbstract
OBJECTIVE: We assessed the incidence and outcomes of graft-related secondary interventions (ie, open conversion or proximal or distal extensions) after elective thoracic endovascular aortic repair (TEVAR) for aneurysmal disease.
METHODS: An institutional review of TEVAR for descending thoracic aortic aneurysms (DTAAs), between 2000 and 2011, was performed. Only elective TEVAR for DTAA using commercially available endografts was selected. Emergent cases, nonaneurysmal aortic pathology (ie, transection, pseudoaneurysm, dissection), and cases that used physician-modified devices were excluded. The incidence of unplanned graft-related secondary interventions was examined and outcomes were analyzed.
RESULTS: During the study period, 83 patients underwent elective TEVAR for DTAA that met the inclusion criteria. Subsequent graft-related secondary interventions were required in eight patients (10%). The mean interval to the secondary intervention was 31.8 months. Endoleak was the most common indication. Patients who required secondary interventions were significantly younger (mean age, 58 ± 12 vs 69 ± 11 years; P < .05). Operative mortality (<30 day) was zero, with one aneurysm-related late death occurring at 2 years after the secondary intervention. Factors that predisposed the need for secondary interventions were fusiform morphology of the aneurysm (P = .05) and extent of graft coverage in the proximal landing zone <3 cm (P < .05). Size of the aneurysm treated and the type of device used were not significant factors leading to secondary intervention.
CONCLUSIONS: Intermediate and long-term results of elective TEVAR for DTAA demonstrate good durability, with acceptable rates of graft-related secondary interventions. Age, fusiform aneurysm morphology, and extent of proximal landing zones <3 cm were significant factors that led to subsequent secondary interventions.
Author List
Lee CJ, Rodriguez HE, Kibbe MR, Malaisrie SC, Eskandari MKMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Aortic Aneurysm, Thoracic
Aortography
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Chi-Square Distribution
Chicago
Disease-Free Survival
Elective Surgical Procedures
Endoleak
Endovascular Procedures
Female
Humans
Incidence
Kaplan-Meier Estimate
Magnetic Resonance Angiography
Male
Middle Aged
Prosthesis Design
Reoperation
Retrospective Studies
Risk Factors
Stents
Time Factors
Tomography, X-Ray Computed
Treatment Outcome