Instabilities in Aortic Length After TEVAR and Reoperation: 12 Years of Follow-Up Imaging

Abstract

Thoracic endovascular aortic repair (TEVAR) remains an important minimally invasive tool for the treatment of descending thoracic aneurysm. The long-term effects of these repairs in reduction of the aneurysmal sac size as well as stability of the stented portion require study. We report the results of 12 years of radiographic follow-up. All patients who underwent TEVAR for descending thoracic aneurysms from January 2005 to December 2017(n= 371) were evaluated for immediate postoperative and follow-up computed tomographic scans suitable for 3-dimensional reconstruction of the aorta (excluding those with an interim reoperation). We found 62 patients who met these criteria (median duration of radiographic follow-up, 1.8 years). Measurements were taken of centerline, greater and lesser curvatures from the most distal patent brachiocephalic vessel to the first uncovered mesenteric vessel, and between proximal and distal edges of the stented portion of the aorta. All measured segments, except covered length, were significantly increasing in length for centerline, greater and lesser curvatures, with a median increase of 7.6mm (interquartile range, 1.7-16 mm). Cox regression formortality and reoperation found no significant correlationbetween these changes and mortality and a significant correlation between stented segment greater curvature increaseand reoperation (adjusted hazard ratio, 1.06; P < .05). Increases in the centerline and greater curve length of the aorta were found to be occurring. This appears to be primarily driven by growth in the nonstented segments. However, changes in the outer curve length of the stented segment were associated with a greater risk of reoperation.