Endovascular Repair versus Open Repair for Isolated Descending Thoracic Aortic Aneurysm

Abstract

PurposeTo compare the outcomes of thoracic endovascular aortic repair (TEVAR) with those of open repair for descending thoracic aortic aneurysms (DTAA).Materials and MethodsWe compared the outcomes of 114 patients with DTAA and proximal landing zones 3 or 4 after TEVAR to those of 53 patients after conventional open repairs. Thirty-day and late mortality were the primary endpoints, and early morbidities, aneurysm-related death, and re-intervention were the secondary endpoints.ResultsThe TEVAR group was older and had more incidences of dissecting aneurysm. The mean follow-up was 36±26 months (follow-up rate, 97.8%). The 30-day mortality in the TEVAR and open repair groups were 3.5% and 9.4% (p=0.11). Perioperative stroke and paraplegia incidences were similar between the groups [5.3% vs. 7.5% (p=0.56) and 7.5% vs. 3.5% (p=0.26), respectively]. Respiratory failure occurred more in the open repair group (1.8% vs. 26.4%, p<0.01). The incidence of acute kidney injury requiring dialysis was higher in the open repair group (1.8% vs. 9.4%, p<0.01). The cumulative survival rate was higher in the TEVAR group at 2 to 5 years (79.6% vs. 58.3%, p=0.03). The free from re-intervention was lower in the TEVAR group (65.3% vs. 100%, p=0.02), and the free from aneurysm-related death in the TEVAR and open repair groups were 88.5% and 86.1% (p=0.45).ConclusionTEVAR is safe and effective for treating DTAAs with improved perioperative and long-term outcomes compared with open repair.

Long-term Outcomes of Intervention between Open Repair and Endovascular Aortic Repair for Descending Aortic Syndrome: A Propensity-Matched Analysis

“…Since, the report on the rst successful open repair of a descending thoracic aortic aneurysm with a prosthetic graft in 1953 by De Bakey and Cooley [11], an open surgical repair for treating descending thoracic aortic disease has been the gold standard for 50 years [11][12][13][14]. Despite remarkably improved operative techniques and maximized organ protection, open repair of the descending thoracic aorta is still associated with high complications, including intraoperative and postoperative death, hemorrhage, stroke, and paraplegia [9,15].…”

“…The treatment modality was decided collaboratively by the cardiologist and cardiac surgeons who were involved in the patients' care; decision was based on the patients' co-morbidities, functional status, anatomical feature of the lesion, and the appropriate of vascular access [9].…”

Successful Intravascular Correction of Intratumoral Pseudoaneurysm by Erosion of the Aorta in a Patient with Thoracic Giant Cell Tumor of Bone Responding to Denosumab

“…Therefore, continuous surveillance for potential complications even in the setting of response is advised during the treatment of patients with GCT, since local aggressiveness, large dimensions, and extension into surrounding tissues frequently characterize the clinical course of these tumors. Endovascular techniques using a stent graft represent less invasive alternatives to open surgical repair in individuals with aortic aneurysms [10, 11]. In a prospective study, endovascular repair was associated fewer late reintervention rates and similar long-term outcomes when compared with open surgical approaches in patients with vascular complications affecting the descending thoracic aorta [11].…”

Long-term outcomes of intervention between open repair and endovascular aortic repair for descending aortic pathologies: a propensity-matched analysis

“…Surgery was performed for patients with complicated acute or chronic descending aortic pathologies. The treatment modality was decided collaboratively by the cardiologist and cardiac surgeons who were involved in the patients’ care; the decision was based on the patients’ co-morbidities, functional status, anatomical feature of the lesion, and the appropriate of vascular access [ 9 ].…”