Long-term results of thoracic endovascular aortic repair in atherosclerotic aneurysms involving the descending aorta
Received 27 April 2010; received in revised form 31 May 2010; accepted 21 June 2010. published online 22 July 2010. Corrected Proof
Objective
This study evaluated long-term results of thoracic endovascular aortic repair for atherosclerotic aneurysms involving descending aorta.
Methods
One hundred thirteen patients underwent thoracic endovascular aortic repair for this indication from 1996 to 2009. Mean follow-up was 54 ± 38 months (5–144 months). In-hospital mortality, neurologic injury, need for rerouting, occurrence of endoleaks and their treatment, and survival were recorded.
Results
In-hospital mortality was 5.3%. Transient neurologic injury rate was 2.6%. Previous rerouting was performed in 51%. Assisted early and late type I and III endoleak rates were 7.9% and 5.7%, respectively. Five percent of patients required late surgical conversion. Actuarial survivals were 86%, 60%, and 42% at 1, 5, and 10 years, respectively. Aorta-related actuarial survivals were 94%, 90%, and 83% at 1, 5, and 10 years, respectively. Cox regression analysis revealed higher number of prostheses as independent risk factor for early (hazard ratio, 5.38; 95% confidence interval, 1.68–42.37) and late (hazard ratio, 8.49; 95% confidence interval, 1.09–66.06) endoleak formation. Female sex (hazard ratio, 0.35; 95% confidence interval, 0.13–0.99), no arch involvement (hazard ratio, 0.21; 95% confidence interval, 0.05–0.08), and higher number of prostheses (hazard ratio, 7.95; 95% confidence interval, 1.36–46.58) affected survival.
Conclusions
Aorta-related survival is excellent among patients undergoing thoracic endovascular aortic repair for atherosclerotic aneurysms involving the descending aorta. Life-long surveillance remains mandatory, with early and late failure uncommon but still needing consideration. Thoracic endovascular aortic repair in this group of patients remains attractive and has now proven durability.
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