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Outcomes and survival following thoracic endovascular repair in patients with aortic aneurysms limited to the descending thoracic aorta.

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  • معلومة اضافية
    • المصدر:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: [London] : BioMed Central, 2006-
    • الموضوع:
      Aortic Aneurysm, Thoracic*/complications ; Blood Vessel Prosthesis Implantation*/adverse effects ; Aortic Aneurysm*/surgery ; Endovascular Procedures*/adverse effects; Humans ; Aged ; Blood Vessel Prosthesis/adverse effects ; Endoleak/etiology ; Retrospective Studies ; Treatment Outcome ; Risk Factors
    • نبذة مختصرة :
      Background: Thoracic endovascular aortic repair (TEVAR) is a well-established therapy for descending aortic aneurysms (DTA). There is a paucity of large series reporting the mid- and long-term outcomes from this era. The main aim of this study was to evaluate the outcomes of TEVAR with regards to the effect of aortic morphology and procedure-related variables on survival, reintervention and freedom from endoleaks.
      Methods: In this retrospective single center study, we evaluated the clinical outcomes among 158 consecutive patients with DTA than underwent TEVAR between 2006 and 2019 at our center. The cohort included 51% patients with device landing zones proximal to the subclavian artery and 25.9% patients undergoing an emergent or urgent TEVAR. The primary outcome was survival, and secondary outcomes were reintervention and occurrence of endoleaks.
      Results: Median follow-up was 33 months [IQR 12 to 70] while 50 patients (30.6%) had longer than 5-year follow-up. With a median patient age of 74 years, post-operative Kaplan Meyer survival estimates were 94.3% (95%CI 90.8-98.0, SE 0.018%) at 30 days, 76.4% (95%CI 70.0-83.3, SE 0.034%) at one year and, 52.9% (95%CI 45.0-62.2, SE 0.043%) at five years. Freedom from reintervention at 30 days, one year, and five years was 92.9% (95%CI 89.0-97.1, SE 0.021%), 80.0% (95%CI 72.6-88.1, SE 0.039%), and 52.8% (95%CI 41.4-67.4, SE 0.065%), respectively. On cox regression analysis greater aneurysm diameter, and the use of device landing zones in aortic regions 0-1 were associated with an increased probability of all-cause mortality, and with reintervention during follow-up. Independent of aneurysm size undergoing urgent or emergent TEVAR was associated with higher mortality risk for the first three years post-operative but not on long-term follow-up.
      Conclusions: Larger aneurysms and those requiring stent-graft landing in aortic zones 0 or 1, are associated with higher risk for mortality and reintervention. There remains a need to optimize clinical management and device design for larger proximal aneurysms.
      (© 2023. The Author(s).)
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    • Contributed Indexing:
      Keywords: Risk factors; TEVAR; Thoracic aneurysms
    • الموضوع:
      Date Created: 20230620 Date Completed: 20230622 Latest Revision: 20230701
    • الموضوع:
      20240829
    • الرقم المعرف:
      PMC10280975
    • الرقم المعرف:
      10.1186/s13019-023-02285-3
    • الرقم المعرف:
      37340389