O064 Management of acute aortic syndrome with evolving individualized precision medicine solutions: lesson learned over two decades and literature review

Abstract

Abstract Introduction Thoracoabdominal acute aortic syndrome is associated with high morbidity and mortality. We aim to scrutinize our evolving strategies for acute aortic syndromes (AAS) management using minimally invasive and adaptive surgical techniques. Methods This is a longitudinal observational study at our tertiary vascular centre from 2002 to 2021. Amongst 96 with symptomatic aortic thoracic pathologies, 71 had AAS. Our primary endpoint was combined aneurysm and cardiovascular-related mortality. Results There were 43 males and 28 females (5 Traumatic Aortic Transection (TAT), 8 Intramural Hematoma (IMH), 27 Symptomatic Aortic Dissection (SAD) and 31 Thoracic Aortic Aneurysm (TAA)) with a mean age of 69. All AAH received optimal medical therapy (OMT) and TAT underwent emergency thoracic endovascular aortic repair (TEVAR). Fifty-eight patients had aortic dissection, of which 31 developed TAA. These 58 received OMT initially and interval surgical intervention with TEVAR or sTaged hybrId sinGle lumEn Reconstruction (TIGER). To increase our landing area, we performed left subclavian chimney graft with TEVAR in 12 patients. Average follow-up was 78.2 months, and 11 patients (15.5%) had combined aneurysm and cardiovascular-related mortality. None had stroke or bowel ischaemia. 26% developed endoleaks, and 15% required re-intervention (type II & III). Four patients had paraplegia (5.7%) and succumbed to death from renal failure. Eight IMH patients on OMT died within 30 days. Conclusion Acute aortic hematoma necessitates close monitoring and early intervention. TIGER technique with interval TEVAR has salvaged complex situations in young patients. Our experience shows that minimally invasive techniques could be a viable option for AAS.