Early Experiences with the Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm

Abstract

BackgroundThe aim of this study was to report our early experiences with the endovascular repair of ruptured descending thoracic aortic aneurysms (rDTAAs), which are a rare and life-threatening condition.MethodsAmong 42 patients who underwent thoracic endovascular aortic repair (TEVAR) between October 2010 and September 2015, five patients (11.9%) suffered an rDTAA.ResultsThe mean age was 72.4±5.1 years, and all patients were male. Hemoptysis and hemothorax were present in three (60%) and two (40%) patients, respectively. Hypovolemic shock was noted in three patients who underwent emergency operations. A hybrid operation was performed in three patients. The mean operative time was 269.8±72.3 minutes. The mean total length of aortic coverage was 186.0±49.2 mm. No 30-day mortality occurred. Stroke, delirium, and atrial fibrillation were observed in one patient each. Paraplegia did not occur. Endoleak was found in two patients (40%), one of whom underwent an early and successful reintervention. During the mean follow-up period of 16.8±14.8 months, two patients died; one cause of death was a persistent type 1 endoleak and the other cause was unknown.ConclusionTEVAR for rDTAA was associated with favorable early mortality and morbidity outcomes. However, early reintervention should be considered if persistent endoleak occurs.

Ruptured isolated descending thoracic aortic aneurysm: open or endovascular repair?

“…In a later study by Botsios et al [21] , the rate of re-intervention is thought to be between 4.5%-16% at 1.5-44 months follow up time. Interestingly this rate reported to be as high as 45.5% after rDTAA in some other studies [6,18] . Such re-interventions can be very drastic and require further major intervention and hence affect the long-term outcomes overall.…”

“…Currently, TEVAR is the standard management plan for elective cases of DTAA [14] , however the evidences behind using TEVAR in the emergency setting are scarce and limited [7] . There are however several published reports from international centers about the clinical outcomes for the use of TEVAR in emergency situations for rDTAA [2,[6][7][8]15] , but most of these are limited to a relatively small number of cases and are observational studies. These studies have been summarized in Table 1.…”

“…Despite TEVAR being an attractive alternative option for OR, it still remains a high-risk procedure. The current literature has many limitations in that the majority of evidence comes from case series and there is a lack of appropriate randomized controlled trials or long term comparative data that confirms the accuracy of the data and thus globalization of the results [6][7][8] . Therefore, the aim of this paper is to review current literature and the evidence behind using TEVAR in the emergency setting of rDTAA and comparing the clinical outcomes with OR in such cohort of patients.…”

Explantation of a failed endovascular stent graft in a patient with a type B dissection

“…7,8 Although the mortality and morbidity rates of TEVAR are lower than those of open surgery, 1,4 the rate of open surgical conversion after failed TEVAR has been reported to range from 4% to 10%. 7,8 Although the mortality and morbidity rates of TEVAR are lower than those of open surgery, 1,4 the rate of open surgical conversion after failed TEVAR has been reported to range from 4% to 10%.…”

“…TEVAR is a widely accepted treatment option for type B acute aortic dissection with or without complications. 7,8 Although the mortality and morbidity rates of TEVAR are lower than those of open surgery, 1,4 the rate of open surgical conversion after failed TEVAR has been reported to range from 4% to 10%. [9][10][11] A type I endoleak is one of the most common causes of secondary surgical intervention in addition to retrograde dissection.…”