Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms

Abstract

Endovascular repair of rDTAA is associated with a lower risk of a composite of death, stroke, and paraplegia, compared with traditional open surgery. In rDTAA patients, endovascular management appears the preferred treatment when this method is feasible.

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…Another recent multicenter, retrospective review of 69 patients with ruptured DTAA published by the same authors demonstrated a composite outcome of death, stroke, or permanent paraplegia in 36.2%. 127 These results were confirmed by a larger study, including data from the US Nationwide Inpatient Sample data on 559 patients with ruptured DTAA, with a reported mortality rate of 28.6%. 128 These data confirm that OR for ruptured DTAA is associated with high mortality and morbidity.…”

“…LSA revascularisation was not performed in most of these cases. 127,128 Comprehensive data regarding the rationale for LSA coverage without revascularisation are unavailable. In one study, subclavian artery bypass was performed in half of the cases (10/19 covered) before TEVAR.…”

“…For DTAA, there is a threshold of 70 mm at which the risk of rupture suddenly escalates. 127 Intervention in aneurysms below 55 mm may not afford a survival benefit, although a randomized controlled trial is necessary to evaluate the possible benefit of repair in the small aneurysm group. 9 This threshold can be reduced to 50e55 mm for women or in the setting of connective tissue disorders (see also Section 3.7.1.).…”

Endovascular Repair of Thoracic Aortic Emergencies

“…Open surgical repair of rDTAA presents very high mortality rates and is only feasible in referral centers. Mortality rates for open surgery vary from 30% to 60% depending on the series (Jonker et al, 2011).…”

“…The risk of neurological complications may increase after endovascular repair of rDTAA, although it is still lower than that of open repair. The incidence of paraplegia and stroke after conventional surgical treatment of rDTAA may be as high as 12.5% and 25% (Jonker et al, 2011;Barbato et al, 2007), providing even greater support for endovascular treatment of rDTAA. Although TEVAR is currently the most appropriate approach for the management of this often-fatal lesion, endovascular repair of rDTAA is still associated with considerable rates of neurological complications and procedure-related complications such as endoleak.…”