IP087. Midterm Results of Endovascular Stent Graft Implantation for the Treatment of Acute Thoracic Aortic Syndromes

Abstract

The goal of this study was to evaluate the outcome of thoracic endovascular stent graft implantation (TEVAR) in the treatment of acute aortic syndromes (AAS) of the descending aorta. From June 1997 to December 2016, 141 patients (79% male) with a median age of 61 years (range, 22-88 years) underwent TEVAR for AAS. Aortic pathologies were descending aortic aneurysm (DTA) in 23 (16%), acute type B aortic dissections (TBD) in 54 (38%), perforating aortic ulcer (PAU) in 40 (29%), and acute traumatic aortic transactions (ATAT) in 24 (17%). Thirty-day mortality and overall survival were evaluated for each group. The overall 30 day mortality was 7% (n = 10). No patient died in the PAU group, 5 patients (4%) in the TBD group, 3 (2%) in the aneurysm group, and 2 (1%) in the ATAT group (P = .17). Seven of the 10 deaths were aortic related. Permanent and temporary neurologic dysfunctions were observed in five patients (PAU, n = 2; TBD, n = 2; DTA, n = 1) and nine patients (PAU, n = 3; TBD, n = 3; ATAT, n = 2; DTA, n = 1; P = ns). Early reintervention (within 30 days) was needed in seven patients in the TBD group. The causes were endoleaks in five patients (type Ia, n = 3; type Ib, n = 1; type Ib and II, n = 1), postdilatation in one patient, and repeat dissection in another patient. Six patients underwent a second intervention, and the remaining one had conventional surgery (P < .005 between the treatment groups). The overall rate of persistent primary and secondary endoleaks was 20% and 7%, respectively (P < .05). Overall mortality was 86%, 82%, and 67% at 1, 2, and 5 years with significant differences between the four treatment groups (P < .05; Fig). The treatment of acute aortic syndromes of the descending thoracic aorta with endovascular stent grafts is a feasible and safe technique. It provides low morbidity and mortality rates in the early postoperative period, and midterm results are encouraging. However, long-term studies are needed to evaluate the effectiveness and the durability of this procedure.