A standard experiment with emergency endovascular interventions on the descending thoracic aorta

Abstract

Background: Using emergency endovascular aortic repair to treat severe acute aortic disorders affecting the descending aorta is an appealing prospect. Aim: This study's objective was to evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in the management of acute surgical emergencies involving the descending thoracic aorta. Methods: The medical records of every patient who underwent TEVAR in a single centre since 2007 were retrospectively evaluated. Emergency criteria for inclusion were used to treat patients with aortic disease who had complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other symptoms calling for urgent treatment. The Society for Vascular Surgery reporting guidelines for thoracic endovascular aortic repair were used to evaluate the technical and clinical success with regard to patient mortality, survival, and re-operation rate (TEVAR). Results: In 74 cases (51.0%), emergency procedures were required, including those involving patients with traumatic aortic acute injuries (TAIs) (31.1%) and complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48). Aortic iatrogenic dissection (AID) in one case and two other fistulas following the prior stent graft were also identified as implantation's. While 2 hybrid operations required extra approaches, all procedures were performed through surgically exposed femoral arteries. The main technical success rate was 95.9%; endoleak was recorded in 3 instances. In 94.5% of cases, the main clinical success was achieved. All of the patients made it through the endovascular procedures, however one of them passed away in the hospital as a result of multi-organ failure (early mortality: 1.3%). 11 patients passed away throughout the follow-up period, which lasted 6 to 164 months (median 67). The probability of survival over one year, five years, and 10 years was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, following TAI (95.2%) compared to scAAS (63.4%), the rate of 5-year survival was significantly greater (p=0.008). One person experienced temporary para-paresis right after the operation (1.3%). Throughout the post-discharge follow-up period, no more severe stent-graft-related adverse events were reported. Conclusion: The probability of survival over one year, five years, and 10 years was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, following TAI (95.2%) compared to scAAS (63.4%), the rate of 5-year survival was significantly greater (p=0.008). One person experienced temporary para-paresis right after the operation (1.3%). Throughout the post-discharge follow-up period, no more severe stent-graft-related adverse events were reported.