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

Abstract

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)

Endovascular Management of Rupture in Acute Type B Aortic Dissections

“…In the case of non-optimal aortic coverage, a secondary procedure must be performed to improve long-term results in stable patients, and should not be considered as failure of TEVAR. 5…”

“…In addition, in the setting of this specific complication, questions remain about the role and length of the stent graft: is coverage of the proximal entry tear sufficient only to stop bleeding or should the stent graft cover the entire dissected aorta with the increased risk of paraplegia? 4,5 The aim of this study is to assess the short-and mid-term results of endovascular stent graft management of acute type B aortic dissections complicated by rupture.…”

TEVAR for ruptured descending thoracic aortic aneurysm: case report

“…Although open surgical repair remains the traditional treatment of rDTAA, TEVAR is a minimally invasive approach that does not requires thoracotomy, aortic cross-clamping, systemic heparin, cardiopulmonary bypass, or hypothermic cardiac arrest. 7 , 8 Moreover, TEVAR enables safe and effective aneurysm exclusion, can be used for treatment of patients in critical conditions, and is associated with shorter operating times, minimal additional blood loss, and lower fluid requirements. 7 , 8 …”

Ruptured isolated descending thoracic aortic aneurysm: open or endovascular repair?

“…A study by Desai et al [29] has reported a survival rate of TEVAR equivalent to OR in patients with rDTAA at 8-10 years of follow up. In a later study by Botsios et al [21] , the rate of re-intervention is thought to be between 4.5%-16% at 1.5-44 months follow up time. Interestingly this rate reported to be as high as 45.5% after rDTAA in some other studies [6,18] .…”

“…Although TEVAR seems an attractive option for managing patients with rDTAA, it cannot be used as a standard management in every patient at the time of presentation due to many factors [3] . Initially the gold standard method for managing such patients was OR [19] , however this method has been challenged by the evolution of TEVAR and the favourable short-term outcomes [16,20,21] . One of the key factors in choosing TEVAR over OR, is the anatomic variations and suitability for TEVAR.…”