Secondary interventions after elective thoracic endovascular aortic repair for degenerative aneurysms

Cheong J. Lee, Heron E. Rodriguez, Melina R. Kibbe, S. Chris Malaisrie, Mark K. Eskandari*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Objective: We assessed the incidence and outcomes of graft-related secondary interventions (ie, open conversion or proximal or distal extensions) after elective thoracic endovascular aortic repair (TEVAR) for aneurysmal disease. Methods: An institutional review of TEVAR for descending thoracic aortic aneurysms (DTAAs), between 2000 and 2011, was performed. Only elective TEVAR for DTAA using commercially available endografts was selected. Emergent cases, nonaneurysmal aortic pathology (ie, transection, pseudoaneurysm, dissection), and cases that used physician-modified devices were excluded. The incidence of unplanned graft-related secondary interventions was examined and outcomes were analyzed. Results: During the study period, 83 patients underwent elective TEVAR for DTAA that met the inclusion criteria. Subsequent graft-related secondary interventions were required in eight patients (10%). The mean interval to the secondary intervention was 31.8 months. Endoleak was the most common indication. Patients who required secondary interventions were significantly younger (mean age, 58 ± 12 vs 69 ± 11 years; P <.05). Operative mortality (<30 day) was zero, with one aneurysm-related late death occurring at 2 years after the secondary intervention. Factors that predisposed the need for secondary interventions were fusiform morphology of the aneurysm (P =.05) and extent of graft coverage in the proximal landing zone <3 cm (P <.05). Size of the aneurysm treated and the type of device used were not significant factors leading to secondary intervention. Conclusions: Intermediate and long-term results of elective TEVAR for DTAA demonstrate good durability, with acceptable rates of graft-related secondary interventions. Age, fusiform aneurysm morphology, and extent of proximal landing zones <3 cm were significant factors that led to subsequent secondary interventions.

Original languageEnglish (US)
Pages (from-to)1269-1274
Number of pages6
JournalJournal of Vascular Surgery
Volume57
Issue number5
DOIs
StatePublished - May 2013

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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