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PVSS7. A 9-Year Experience With Endovascular Thoracic Aortic Repair: Long-Term Follow-Up And Lessons Learned

Juan Carlos Pereda, Sharif H. Ellozy, Vimal Ramjee, Alfio Carroccio, Tikva S. Jacobs, Omar C. Morcos, Robert A. Lookstein, Victoria J. Teodorecu, Michael L. Marin.
Division of Vascular Surgery, Mount Sinai School of Medicine, New York, N.Y., Mount Sinai School of Medicine; New York, N.Y.

OBJECTIVES: Endovascular aneurysm repair has become an important part of the surgical armamentarium used to treat thoracic aortic aneurysms, however long-term data remains scant. This study is a single-institution retrospective review of 152 thoracic endovascular aneurysm repairs (TEVAR) completed with first- and second- generation commercially produced thoracic stent-grafts.

METHODS: Over a 9 year period, 152 endovascular stent-graft repairs of thoracic aortic aneurysms were attempted. The mean age of this cohort was 70 years±17 years. There were 99 men and 53 women who received TEVAR. Successful endograft deployment was achieved in 149 patients (98%). Primary technical success was achieved in 143 patients (94%). The mean length of hospital stay for TEVAR patients was 5.5 days±9.7 days (mode, 1 day).

RESULTS: Thirty-six procedures (23.4%) were performed emergently. Peri-operative mortality occurred in 3 of 36 (8.3%) emergent TEVAR patients, and 4 of 116 (3.4%) elective TEVAR patients. Seven procedures (4.6%) were ultimately converted to open repair, this occurred in 2 emergent (5.5%) and 5 elective patients (4.3%). None of the 5 elective patients required conversion in the early post-operative period. Clinical success was achieved in 134 patients (87%). 13 patients (8.6%) developed with type I endoleak and 5 patients (3.9%) demonstrated type III endoleaks in postoperative follow-up. Overall, only 3 pts (2%) suffered a peri-operative stroke and 6 (4%) suffered early or delayed spinal cord ischemia. At 96 months, overall survival was 67% (±5%).

CONCLUSIONS: Our experience highlights the safe implementation of TEVAR with a low incidence of perioperative morbidity and mortality and acceptable durability. After successful treatment, long-term mortality appears to be mostly related to medical comorbidities. Continued improvements in device delivery and durability will only increase the applicability of this technology.