Outcomes of endovascular repair of ruptured descending thoracic aortic aneurysms
Background-: Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors that affect these outcomes. Methods and Results-: We retrospectively investigated the outcomes of 87 patients who underwent thoracic endovascular aortic repair for rDTAA at 7 referral centers between 2002 and 2009. The mean age was 69.8±12 years and 69.0% of the patients were men. Hypovolemic shock was present in 21.8% of patients, and 40.2% were hemodynamically unstable. The 30-day mortality rate was 18.4%, and hypovolemic shock (odds ratio 4.75; 95% confidence interval, 1.37 to 16.5; P=0.014) and hemothorax at admission (odds ratio 6.65; 95% confidence interval, 1.64 to 27.1; P=0.008) were associated with increased 30-day mortality after adjusting for age. Stroke and paraplegia occurred each in 8.0%, and endoleak was diagnosed in 18.4% of patients within the first 30 days after thoracic endovascular aortic repair. Four additional patients died as a result of procedure-related complications during a median follow-up of 13 months; the estimated aneurysm-related mortality at 4 years was 25.4%. Conclusion-: Endovascular repair of rDTAA is associated with encouraging results. The endovascular approach was associated with considerable rates of neurological complications and procedure-related complications such as endoleak.
|Keywords||acute kidney failure, aged, aneurysm, aneurysm surgery, aorta, aorta rupture, article, cerebrospinal fluid drainage, descending aorta, descending thoracic aorta aneurysm rupture, endoleak, endovascular surgery, female, follow up, heart disease, hematothorax, hemodynamics, human, hypovolemic shock, major clinical study, male, mortality, paraplegia, postoperative complication, postoperative hemorrhage, priority journal, reoperation, respiratory tract disease, retrospective study, stent, stroke, surgery, surgical technique, survival, survival rate, survival time, thoracic aorta aneurysm, thoracic endovascular aortic repair|
|Persistent URL||dx.doi.org/10.1161/CIRCULATIONAHA.109.908871, hdl.handle.net/1765/20691|
|Note||Free full text at PubMed|
Jonker, F.H.W, Verhagen, H.J.M, Lin, P.H, Heijmen, R.H, Trimarchi, S, Lee, W.A, … Muhs, B.E. (2010). Outcomes of endovascular repair of ruptured descending thoracic aortic aneurysms. Circulation (Baltimore), 121(25), 2718–2723. doi:10.1161/CIRCULATIONAHA.109.908871