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Home > Vascular Annual Meeting > manish_endovascular_vs_open

Endovascular Vs. Open Surgical Repair Of Ruptured Thoracic Aortic Aneurysms: Mid-Term Outcomes Of A Prospective Intent-To-Treat Study

Manish Mehta, R. Clement Darling, III, Philip S. K. Paty, Sean P. Roddy, John B. Taggert, Yaron Sternbach, Paul B. Kreienberg, Kathleen J. Ozsvath, Benjamin B. Chang, Dhiraj M. Shah.
Albany Medical College, Albany, N.Y.

OBJECTIVES: Despite improvements in perioperative diagnosis, treatment, and postoperative care, surgical repair of ruptured thoracic aortic aneurysms (r-TAA) continues to have a high morbidity and mortality. In this intent-to-treat longitudinal study, we compare our results of endovascular verses open surgical repair for all r-TAA.

METHODS: Since 2005, patients presenting with r-TAA at our institution have primarily undergone thoracic endovascular aneurysm repair (TEVAR), and this experience was compared to patients that underwent open surgical repair of r-TAA over the past decade. One hundred and twenty-one patients presented to our institution with r-TAA and underwent repair via endovascular (n=52, 43%) or open surgical approach (n=69, 57%). Data was prospectively collected in a vascular registry and statistical analysis was performed using Chi square and life table methods.

RESULTS: The utilization of endovascular techniques for treating ruptured TAA increased over time (before 2005, 0%; 2005, 29%; 2006, 67%; 2007, 90%) When compared to open surgical group, the endovascular group had significantly higher preexisting comorbidities (CAD: 47% vs. 17%, HTN: 69% vs. 30%, COPD: 21% vs. 4%, CRI: 16% vs. 4%; p<0.05). Over a mean follow-up of 15 months, 11% of the patients in the endovascular group and 16% of the patients in the open surgical group required secondary adjunctive procedures. When compared to the endovascular group, neurological complications including paraplegia/ stroke occurred more frequently in the open surgical group (16% vs. 5%). Life table analysis indicated the cumulative survival rate for the endovascular group (30-day, 71%; 1 year, 51%; 2 year, 45%; 3 year, 45%) was significantly better than for the open surgical group (30-day, 44%; 1 year, 33%; 2 year, 33%; 3 year, 26%; 4 year, 14%; 5 year, 14%).

CONCLUSIONS: Endovascular repair of r-TAA is associated with markedly reduced mortality and improved mid-term survival when compared to the open surgical approach. Furthermore, endovascular therapy might increase our ability to treat patients with r-TAA and significant co-morbidities that might have otherwise been left untreated.

AUTHOR DISCLOSURES: M. Mehta, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; Medtronic Advisory Board; Cordis Advisory Board; W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; R. Darling, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; P.S.K. Paty, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; S.P. Roddy, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; J.B. Taggert, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; Y. Sternbach, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; P.B. Kreienberg, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; Sanofi/Aventis; K.J. Ozsvath, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; B.B. Chang, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular; D.M. Shah, W.L. Gore & Associates; Medtronic AVE; Cordis Endovascular.