Predictors of morbidity and mortality with endovascular and open thoracic aneurysm repair

Dillavou, Ellen D.; Makaroun, Michel S.

doi:10.1016/j.jvs.2008.06.019

Cited by 31 publications

(31 citation statements)

References 23 publications

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“…This has been suggested in previous studies, 17,19,20 but ours is the first to note this finding with adjustment for sheath and artery sizes. The reason for these differences is unknown but has also been noted in literature about other endovascular catheter-based procedures 21,22 and may be because of differences in vessel characteristics, tortuosity, and calcification, as well as smaller body size of female patients. Of note, the increased risk of female sex on vascular complications was only noted in percutaneous patients and not in OS patients.…”

Section: Discussionmentioning

confidence: 98%

Factors Associated With Vascular Complications in Patients Undergoing Balloon-Expandable Transfemoral Transcatheter Aortic Valve Replacement via Open Versus Percutaneous Approaches

Kadakia

Herrmann

Desai

et al. 2014

Circ: Cardiovascular Interventions

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Section: Discussionmentioning

confidence: 98%

Factors Associated With Vascular Complications in Patients Undergoing Balloon-Expandable Transfemoral Transcatheter Aortic Valve Replacement via Open Versus Percutaneous Approaches

Kadakia

Herrmann

Desai

et al. 2014

Circ: Cardiovascular Interventions

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“…The etiology of these complications after conventional or hybrid surgical treatment is usually multifactorial and hardly defined, but it is associated with the extent of the treated aortic segment, the use of extracorporeal circulation and clamping time [21]. As reported by Dillavou et al [22], analyzing only patients treated with TAA, the incidence of paraplegia and mortality was significantly lower with the hybrid treatment (3% and 2% respectively) than with conventional treatment (13% and 10%). The incidence of cerebrovascular accident (CVA) in both methods was similar (4%).…”

Section: Discussionmentioning

confidence: 95%

Tratamento híbrido das doenças complexas da aorta torácica

Ingrund¹,

Nasser²,

Jesus-Silva³

et al. 2010

Rev Bras Cir Cardiovasc

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Background: Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery.Objectives: To evaluate the technique and results of hybrid procedures for CTAD.Methods: During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans. Results:The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. INGRUND, JC ET AL -Hybrid procedures for complex thoracic aortic diseasesRev Bras Cir Cardiovasc 2010; 25(3): 303-310 procedures are linked to relevant incidence of paraplegia (6% to 11%) and cerebrovascular accident (3% to19%) [10].Although endovascular treatment of originated and confined lesions to the descending and abdominal aorta represent an important advance in medical practice, the repair of CTDA is difficult as a result of the necessity of surgical intervention in one or more supra-aortic trunks [11,12]. This approach is necessary in order to increase the zone of proximal anchor stent, while preserving the upper limbs and cerebral blood flow. In contrast, recent technological advances in making these devices allowed the treatment of lesions with complex anatomy, previously considered contraindicated for endovascular treatment [13]. The three-dimensional knowledge of anatomy and the involvement of its branches are crucial for the hybrid treatment planning, especially for the aortic arch. The open anatomical surgeries (in-situ) and extra-anatomic revascularization of the supra-aortic trunks provide a proximal segment of the aorta free from disease suitable for anchoring the stent.This study was conducted with the purpose of exposing the hybrid correction results of CTDA, in terms of immediate and medium-term results and its complications. METHODSIt is about longitudinal, retrospective and observational case series. From

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“…life expectancy, functional recovery, and major adverse events) need to become the focus of studies highlighting the potential efficacy of endovascular therapy in the thoracic aorta. While previous reports have documented univariate predictors for short-term mortality after TEVAR 20 they are limited by small sample size and low event rates.…”

Section: Discussionmentioning

confidence: 95%

Preoperative prediction of mortality within 1 year after elective thoracic endovascular aortic aneurysm repair

Scali

Chang

Feezor

et al. 2012

Journal of Vascular Surgery

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Objective Thoracic Endovascular Aortic Repair (TEVAR) is known to have a mortality benefit over open repair in patients with descending thoracic aneurysms, and has become a mainstay of therapy. Because death before 1 year after TEVAR likely indicates an ineffective therapy, we have created a predictive model for mortality within 1-year using factors available in the preoperative setting. Methods A registry of 526 TEVARs performed at the University of Florida between September 2000 and November 2010 was queried for patients with degenerative descending thoracic aneurysm as their primary pathology. Procedures with emergent or urgent indications were excluded. Pre-operatively available variables such as baseline co-morbidities, anatomic and procedure specific planning details were recorded. Univariate predictors of mortality were analyzed with multivariable Cox proportional hazards to identify independent predictors of 30-day and 1-year mortality, defined as mortality within 30 days and within one year following TEVAR, respectively. Results A total of 224 patients were identified and evaluated. Thirty-day and 1-year mortality were 3% (n=7) and 15% (n=33). Multivariable predictors of 1-year mortality included: age >70 (p=0.001, HR 5.8, 95% CI 2.1–16.0), adjunctive intra-operative procedures (e.g. brachiocephalic/visceral stents, concomitant arch de-branching procedures) (p=0.001, HR 4.5, 95% CI 1.9–10.8), peripheral arterial disease (PAD; p=0.006, HR 3.0, 95% CI 1.4–6.7), coronary artery disease (CAD; p=0.02, HR 2.4, 95% CI 1.1–4.9), and chronic obstructive pulmonary disease (COPD; p=0.06, HR 1.9, 95% CI 1.0–3.9). A diagnosis of hyperlipidemia was protective (p=0.006, HR 0.4, 95% CI 0.2–0.7). When patients are grouped into those with 0, 1, 2, 3 or 4+ of these risk factors, the predicted one year mortality was 1, 3, 10, 27 and 54%, respectively. Conclusions Factors are available in the pre-operative setting that are predictive of mortality within 1-year after TEVAR, and can guide clinical decision-making regarding the timing of repair. Patients with multiple risk factors such as age ≥70, CAD, COPD, and a need for an extensive procedure involving adjunctive therapies have a high predicted mortality within one year, and may be best served by waiting for a larger aneurysm size to justify the risk of intervention.

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Predictors of morbidity and mortality with endovascular and open thoracic aneurysm repair

Cited by 31 publications

References 23 publications

Factors Associated With Vascular Complications in Patients Undergoing Balloon-Expandable Transfemoral Transcatheter Aortic Valve Replacement via Open Versus Percutaneous Approaches

Factors Associated With Vascular Complications in Patients Undergoing Balloon-Expandable Transfemoral Transcatheter Aortic Valve Replacement via Open Versus Percutaneous Approaches

Tratamento híbrido das doenças complexas da aorta torácica

Preoperative prediction of mortality within 1 year after elective thoracic endovascular aortic aneurysm repair

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