Thoracic endovascular aortic repair: Evolution of therapy, patterns of use, and results in a 10-year experience

Desai, Nimesh D.; Pochettino, Alberto; Szeto, Wilson Y.; Moser, G.; Moeller, Patrick; Sodhi, Nishtha; Jackson, Benjamin M.; Woo, Edward Y.; Fairman, Ronald M.; Bavaria, Joseph E.

doi:10.1016/j.jtcvs.2011.02.050

Cited by 59 publications

(45 citation statements)

References 24 publications

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“…These numbers are similar to the 3-year survival of 60% [4] and 9.8-year survival of 51% [14] reported by other large, tertiary referral centers. The long-term survival data are quite humbling, and it is evident from this and other studies, including modern series of open aortic repair from centers of excellence [15–18], that patients with descending thoracic and thoracoabdominal aortic disease represent a unique subgroup of patients at notable risk for late death, despite correction of their aortic pathology (Table 5).…”

Section: Commentsupporting

confidence: 88%

Results of Thoracic Endovascular Aortic Repair 6 Years After United States Food and Drug Administration Approval

Shah¹,

Barfield²,

Andersen³

et al. 2012

The Annals of Thoracic Surgery

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Background Since United States Food and Drug Administration approval in 2005, the short-term safety and efficacy of thoracic endovascular aortic repair (TEVAR) have been established. However, longer-term follow-up data remain lacking. The objective of this study is to report 6-year outcomes of TEVAR in clinical practice. Methods A prospective cohort review was performed of all patients undergoing TEVAR at a single referral institution between March 2005 and May 2011. Rates of reintervention were noted. Overall and aortic-specific survival were determined using Kaplan-Meier methods. Log-rank tests were used to compare survival between groups. Results During the study interval, 332 TEVAR procedures were performed in 297 patients. Reintervention was required after 12% of procedures at a mean of 8 ± 14 months after initial TEVAR and was higher in the initial tercile of patients (15.0% vs 9.9%). The 6-year freedom from reintervention was 84%. Type I endoleak was the most common cause of reintervention (5%). Six-year overall survival was 54%, and aorta-specific survival was 92%. Long-term survival was significantly lower than that of an age- and sex-matched United States population (p < 0.001). Survival was similar between patients requiring a reintervention vs those not (p = 0.26). Survival was different based on indication for TEVAR (p = 0.007), and patients with degenerative aneurysms had the lowest survival (47% at 6 years). Cardiopulmonary pathologies were the most common cause of death (27 of 93 total deaths). Conclusions Long-term aortic-related survival after TEVAR is high, and the need for reintervention is infrequent. However, overall long-term survival is low, particularly for patients with degenerative aneurysms, and additional work is needed to identify patients unlikely to derive a survival benefit from TEVAR.

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Section: Commentsupporting

confidence: 88%

Results of Thoracic Endovascular Aortic Repair 6 Years After United States Food and Drug Administration Approval

Shah¹,

Barfield²,

Andersen³

et al. 2012

The Annals of Thoracic Surgery

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“…Revascularization of the left subclavian artery is not mandatory [10]. Only symptomatic patients, who suffer hand or brain ischemia, require surgical revascularization [11]. In the present case, blood pressure on the left arm was sufficient.…”

Section: Discussionmentioning

confidence: 76%

Hemoptysis as a first symptom of endoleak after thoracic endovascular aortic repair, which caused aortic rupture and required complex management.

Synowiec¹,

Warot²,

Burchard³

et al. 2013

Videosurgery and Other Miniinvasive Techniques

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Thoracic endovascular aortic repair (TEVAR) has become the most common procedure in the treatment of thoracic aorta aneurysms. However, potential long-term complications of this technique could be life-threatening. Hemoptysis is a common symptom of lung tumor, especially cancer. On the other hand, hemoptysis can also be caused by bronchitis, tuberculosis, mycosis, and trauma. In this case report, we present a patient with hemoptysis and lung tumor suggesting lung cancer, which was a unique symptom of type IA endoleak after TEVAR and led to rupture of the thoracic aneurysm. It was decided to perform next an endovascular procedure due to the severe state of the patient. Next the thoracotomy was performed because drainage of the left pleural cavity was unsuccessful. In the last stage bronchoscopy was needed to remove the thrombus, which occluded the left main bronchi. Successful management has led to the patient's full recovery. Despite justified popularity of endovascular procedures in the treatment of thoracic aorta aneurysms, we should remember about potential long-term complications. Hemoptysis could be a unique symptom of the endoleak after TEVAR and treatment of such complications could be complex and demanding.

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“…6 Desai et al recently reported excellent long-term results for TEVAR. 12 Early mortality after TEVAR for complicated type B dissection was 7.7%. Serious complications of stent implantation, however, such as occlusion of the left subclavian artery, inadequate device placement, and type I endoleak, have also been reported.…”

Section: Discussionmentioning

confidence: 95%

Clinical Outcome of Emergency Surgery for Complicated Acute Type B Aortic Dissection

Murashita

Ogino

Matsuda

et al. 2012

Circ J

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Thoracic endovascular aortic repair: Evolution of therapy, patterns of use, and results in a 10-year experience

Cited by 59 publications

References 24 publications

Results of Thoracic Endovascular Aortic Repair 6 Years After United States Food and Drug Administration Approval

Results of Thoracic Endovascular Aortic Repair 6 Years After United States Food and Drug Administration Approval

Hemoptysis as a first symptom of endoleak after thoracic endovascular aortic repair, which caused aortic rupture and required complex management.

Clinical Outcome of Emergency Surgery for Complicated Acute Type B Aortic Dissection

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