LONG-TERM OUTCOMES AND RISK FACTORS ANALYSIS FOR PATIENTS UNDERGOING THORACIC ENDOVASCULAR AORTA REPAIR (TEVAR), ACCORDING TO THE AORTIC PATHOLOGIES.

Gallo, Michele; van den Berg, Jos C; Torre, Tiziano; Riggi, Manuela; Demertzis, Stefanos; Ferrari, Enrico (2023). LONG-TERM OUTCOMES AND RISK FACTORS ANALYSIS FOR PATIENTS UNDERGOING THORACIC ENDOVASCULAR AORTA REPAIR (TEVAR), ACCORDING TO THE AORTIC PATHOLOGIES. Annals of vascular surgery, 94, pp. 362-368. Elsevier 10.1016/j.avsg.2023.02.012

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OBJECTIVE

Thoracic endovascular aortic repair (TEVAR) has become a standard treatment for acute and chronic thoracic aorta diseases. We analysed long-term outcomes and risk factors of TEVAR procedures according to the aortic pathology.

METHODS

Demographics, indications, technical details, and outcomes of patients undergoing TEVAR procedures in our institutions were prospectively collected and retrospectively analyzed. Overall survival was determined using Kaplan-Meier methods while Log-rank tests were used to compare the survival between groups. Cox regression analysis was used to identify risk factors.

RESULTS

Between June 2002 and April 2020, 116 patients underwent TEVAR for different thoracic aorta diseases. Among them, 47 patients (41%) underwent TEVAR for aneurysmatic aortic disease, 26 (22%) for type-B aortic dissection, 23 (20%) for penetrating aortic ulcer, 11 (9%) after previous type-A dissection treatment and 9 (8%) for traumatic aortic injury. Patients with post-traumatic aortic injury were younger (p<0.01), with less hypertension (p<0.01), diabetes (p<0.01) and prior cardiac surgery (p<0.01). Survival was different based on indication for TEVAR (log rank 0.024). Patients after previous type-A dissection treatment had the worst survival rate (50% at 5 years) while survival for aneurysmatic aortic disease was 55% at 5 years. No late death occurred in the traumatic group. Cox-regression model identified independent predictors for mortality: age (HR 1.05, 95% CI 1.01-1.09, p= 0.006), male gender (HR 3.2, 95% CI 1.1-9.2, p=0.028), moderate COPD (HR 2.1, 95% CI 1.02-4.55, p=0.043), previous cardiac surgery (HR 2.1, 95% CI 1.008-4.5, p=0.048), and treatment indication for aneurysm (HR 2.6, 95% CI 1.2-5.2, p=0.008).

CONCLUSIONS

TEVAR is a safe and effective procedure with excellent long-term results in case of traumatic aortic injury. The overall long-term survival is affected by aortic pathology, associated comorbidities, gender and previous cardiac surgery.

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