Endovascular repair of ruptured thoracic aortic aneurysms is associated with high perioperative mortality and morbidity

Geisbüsch, Philipp; Kotelis, Drosos; Weber, Tim Frederik; Hyhlik‐Dürr, A.; Böckler, Dittmar

doi:10.1016/j.jvs.2009.08.049

Cited by 30 publications

(23 citation statements)

References 22 publications

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“…The incidence of respiratory complications after TEVAR for thoracic aortic rupture has been reported in the range of 15e 39%. 2,4,5,22,25 A recent nationwide study on use and outcomes of TEVAR for ruptured thoracic aortic aneurysms reported that respiratory complications were alarmingly high at 63%, and even higher in the TEVAR group compared with conventional repair. 3 However, when pleural effusion or HTX were eliminated from the final analysis the respiratory complications were lower in the TEVAR group.…”

Section: Population Based Analysis and Single Center Studies Have Repmentioning

confidence: 99%

Hemothorax Management After Endovascular Treatment For Thoracic Aortic Rupture

Piffaretti

Menegolo

Kahlberg

et al. 2015

European Journal of Vascular and Endovascular Surgery

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Thoracic aortic rupture still has a high mortality rate. Respiratory complications have not been eliminated by endovascular repair. HTX evacuation may have had a positive influence on the survival in these patients. Although traumatic and degenerative ruptures are two significantly different scenarios, survival and respiratory outcomes were similar and were not affected by the underlying aortic disease.

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Section: Population Based Analysis and Single Center Studies Have Repmentioning

confidence: 99%

Hemothorax Management After Endovascular Treatment For Thoracic Aortic Rupture

Piffaretti

Menegolo

Kahlberg

et al. 2015

European Journal of Vascular and Endovascular Surgery

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“…Despite an initial successful TEVAR, the main drawback is the development of procedure‐related complications that need additional secondary endovascular or conventional surgical interventions . There is a 4.5–16% reported incidence of late secondary interventions based on a very heterogenic follow‐up duration . In our series, two patients underwent early secondary interventions (a second TEVAR within one week of the first session) and six patients had major late complications that required a total of seven secondary interventions.…”

Section: Discussionmentioning

confidence: 81%

“…TEVAR has emerged as an alternative to open surgery for acute rupture of different aortic pathologies . Currently, there is little experience regarding emergency TEVAR for patients with nontraumatic rupture of the descending thoracic aorta and their follow‐up duration is limited …”

mentioning

confidence: 99%

Endovascular Treatment for Nontraumatic Rupture of the Descending Thoracic Aorta: Long-Term Results

et al. 2014

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Background This study evaluated the long‐term results of thoracic endovascular aortic repair (TEVAR) of nontraumatic rupture of the descending thoracic aorta. Methods This was a retrospective and observational single‐center study. During the 10‐year study period, 21 patients (6 males) with an average age of 66.1 ± 12.4 (range 31–81) years underwent emergency TEVAR for nontraumatic rupture of the descending thoracic aorta. The underlying aortic pathologies causing the rupture were degenerative aneurysms in 11 patients, complicated type B dissection in nine, and erosion hemorrhage due to neoplasia in one patient. Results The 30‐day mortality rate was 9.5% (2/21). Two patients died postoperatively: one from a repeat aortic rupture and the other from pneumonia. Two patients underwent early endovascular reintervention. After a median follow‐up of 65.6 ± 50.4 (range 1.5–44) months, 10 patients died, resulting in a late mortality of 52.6% (10/19). Six patients (31.5%) developed major complications requiring late reintervention. There was no mortality with reintervention. Conclusions Endovascular treatment of the descending thoracic aorta in patients with nontraumatic rupture is a promising treatment option in an emergency setting with a relatively low mortality rate. Despite encouraging early results, TEVAR is associated with a high reintervention rate and poor survival due to nonaortic or procedure‐related mortality in the long term. doi: 10.1111/jocs.12329 (J Card Surg 2014;29:353–358)

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“…21 Yet this has not precluded the use of TEVAR for patients with ruptured aneurysms, as evidenced by reports from multiple centers. This trend reflects the commencement of a paradigm shift in the approach to treating this formidable surgical challenge.…”

Section: Article See P 2718mentioning

confidence: 99%