Endovascular Repair In Patients With Heritable Thoracic Aortic Disease

Abstract

<h3>INTRODUCTION AND OBJECTIVES</h3> In patients with heritable thoracic aortic disease (HTAD), endovascular repair of aortic aneurysm and dissection may be lifesaving but is associated with increased risk of complications. This study reports our experience with endovascular aortic and branch vessel repair in patients with HTAD. <h3>METHODS</h3> A retrospective analysis of patients with HTAD at our institution who underwent endovascular aortic and/or branch vessel repair was performed. <h3>RESULTS</h3> Twenty-nine patients with HTAD (20 male; mean age 45 ± 13 years) underwent 37 endovascular procedures between 2006-2020. Indications for repair were acute complications of aortic dissection (n=10) or aneurysm rupture (n=3), and elective aortic repair (n=18; 10 chronic dissections and 8 chronic aneurysms). Six procedures repaired branch vessel aneurysms or dissections. Twenty-five (68%) proximal landing zones were in the native vessel, 11 (30%) were in a surgical graft or elephant trunk and 1 was in an endograft. Outcomes are listed in Table I. Thirty-six (97%) procedures were technically successful and none required surgical conversion. Two patients (7%) died: one from sepsis (33 days post-procedure) and one from presumed pseudoaneurysm rupture (116 days post-procedure). Two procedures were complicated by stroke and one patient developed paraparesis. Six aortic endografts (16%) developed stent-induced new entry tears (SINEs) identified 20 ± 15 days post-procedure. Seven endografts (19%) developed a Type I endoleak and 9 (24%) developed a Type II endoleak. Within 30 days, 2 (5%) endografts required reintervention. After 30 days, 15 additional endografts (41%) required reintervention. <h3>CONCLUSIONS</h3> Endovascular repair in select patients with HTAD can manage acute and chronic complications of aortic aneurysm and dissection at relatively low risk. However, risk of endoleaks, SINEs, and reinterventions is high.