Endovascular repair of thoracic and thoraco-abdominal aortic lesions

BACKGROUND: We report our “real-world” experience of endovascular repair of thoracic/thoraco-abdominal aortic lesions in patients treated from May 2002 to May 2017. METHODS: Data of all consecutive treated patients were retrospectively collected in a database and analyzed. Patients were divided into 4 groups: atherosclerotic thoracic/thoraco-abdominal aneurysms (TAA/TAAA) and floating thrombus (group A); acute complicated type B dissection (TBD), penetrating aortic ulcers (PAU) and intra-mural hematomas (IMH) in group B; chronic TBD evolving in TAA (group C); traumatic injuries (group D). Mortality, reinterventions and occurrence of neurological complications, both at 30 days and in the long term, were analyzed as primary outcomes for each group. RESULTS: Ninety-four patients were treated complessively, most for a TAA (55.3%). Thirty-days deaths and neurological complications were observed in group A only (5 cases each, 5.3%). A reintervention was necessary in 6 patients (6.4%) of group A. At 5 years, in group A survival was 62.8%±6.3% and freedom from neurological complication was 88.3%±4.2%. Neither deaths nor neurological complications were recorded in the other groups. No late aortic ruptures were recorded. Freedom from reintervention in group A was 54.7%±7.6% at 5 years and a reintervention was needed in all patients of group D. Overall, the main cause for reintervention was a type I endoleak. CONCLUSIONS: The endovascular repair of thoracic/thoraco-abdominal aortic lesions had acceptable mortality and neurological complication rates, both at 30 days and in the long term. Reinterventions in the long term occurred more frequently after TAA/TAAA and traumatic injuries, and were mainly required for a type I endoleak.