Endovascular Repair for Diverse Pathologies of the Thoracic Aorta: An Initial Decade of Experience

BACKGROUND: Enclovasculargrafts have rapidly evolved as a minimally invasive treatment for a variety of acute and chronic disorders of the thoracic aorta. Application of this technology at a single center is reported. STUDY DESIGN: Between 1998 and 2007, 197 patients underwent thoracic endovascular aortic repair. Primary indications included degenerative aneurysms (n = 121), type B aortic dissection (n = 44), mycoric aneurysms (n = 9), traumatic disruptions (n = 9), intramural hematoma (n = 5), pseudoaneurysm (n = 4), and miscellaneous pathology (n = 5). An analysis of patient demographics, periprocedural records, complications, reinterventions, and survival was conducted. RESULTS: Thirty-day mortality was 6%, which was lowest among patients undergoing treatment for a degenerative thoracic aortic aneurysm (2.4%, 3 of 121). Major adverse events Included stroke in 3%, spinal cord ischemia in 2%, peripheral vascular repair in 4.5%, renal failure ill 4.5%, and open conversion Ill one patient (0.5%). Both preoperative serum creatinine (odds ratio 1.44, 95% CI 1.02 to 2.04, p = 0.039) and number of endograft components (odds ratio 1.43, 95% CI 1.01 to 2.01, p = 0.043) were predictors of major adverse events. Kaplan-Meier analysis revealed a reduction ill late Survival among patients with preoperative creatinine >= 1.8 mg/dL (p < 0.001). One- and 5-year Intervention-free Survivals were 77% +/- 3% and 41% +/- 6%, respectively. CONCLUSIONS: Thoracic enclovascular aortic repair represents an effective treatment for a variety of pathologic states. But the risk-benefit analysis for thoracic endovascular aortic repair should carefully consider the extent of disease, pathologic condition, and renal function. (J Am Coll Surg 2009; 208:802-818. (C) 2009 by the American College of Surgeons)