Yonsei Med J.  2015 Jul;56(4):904-912. 10.3349/ymj.2015.56.4.904.

Endovascular Repair versus Open Repair for Isolated Descending Thoracic Aortic Aneurysm

• Lee HC
• Joo HC
• Lee SH
• Lee S
• Chang BC
• Yoo KJ
• Youn YN

• KMID: 2366328
• DOI: http://doi.org/10.3349/ymj.2015.56.4.904

Abstract

PURPOSE
To compare the outcomes of thoracic endovascular aortic repair (TEVAR) with those of open repair for descending thoracic aortic aneurysms (DTAA).
MATERIALS AND METHODS
We 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.
RESULTS
The 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).
CONCLUSION
TEVAR is safe and effective for treating DTAAs with improved perioperative and long-term outcomes compared with open repair.

Keyword

Aortic aneurysm; aorta; descending; endovascular procedures; cardiovascular surgical procedures; outcome assessment

MeSH Terms

Age Factors
Aged
Aneurysm, Dissecting/*epidemiology/surgery
Aortic Aneurysm, Thoracic/mortality/*surgery
Aortic Rupture/mortality/*surgery
Blood Vessel Prosthesis Implantation
Endovascular Procedures
Female
Humans
Incidence
Male
Middle Aged
Republic of Korea
Stroke/etiology
Survival Rate
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Rates of overall survival, free from aorta-related death, and free from re-intervention. TEVAR, thoracic endovascular aortic repair.

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  Fig. 2 Predictors of aneurysm-related death. HTN, hypertension; DM, diabetes mellitus; CAOD, coronary artery obstructive disease; TEVAR, thoracic endovascular aortic repair; CI, confidence interval.

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