Emergent repair of acute thoracic aortic catastrophes: a comparative analysis.

Arch Surg 2012 Mar;147(3):243-9

Division of Vascular Surgery, Northwestern University, 676 N St Clair, Ste 650, Chicago, IL 60611, USA.

Objective: To provide a contemporary institutional comparative analysis of expedient correction of acute catastrophes of the descending thoracic aorta (ACDTA) by traditional direct thoracic aortic repair (DTAR) or thoracic endovascular aortic repair (TEVAR).

Design: Single-center retrospective review (April 2001-January 2010).

Setting: Academic medical center.

Patients: One hundred patients with ACDTA treated with either TEVAR (n = 76) or DTAR (n = 24). Indications for repair included ruptured degenerative aneurysm (n = 41), traumatic transection (n = 27), complicated acute type B dissection (n = 20), penetrating ulcer (n = 4), intramural hematoma (n = 3), penetrating injury (n = 3), and embolizing lesion (n = 2).

Main Outcome Measures: Demographics and 30-day and late outcomes were analyzed using multivariate analysis over a mean follow-up of 33.8 months.

Results: Among the 100 patients, mean (SD) age was 58.5 (17.3) years (range, 18-87 years). Demographics and comorbid conditions were similar between the 2 groups, except more patients in the DTAR group had prior aortic surgery (P = .02) and were older (P = .01). Overall 30-day mortality was significantly better among the TEVAR group (8% vs 29%; P = .007). Incidence of postoperative myocardial infarction, acute renal failure, stroke, and paraplegia/paresis was similar between the 2 treatment groups (TEVAR, 5%, 12%, 8%, and 8% vs DTAR, 13%, 13%, 9%, and 13%, respectively). Major respiratory complications were lower in the TEVAR group (16% vs 48%; P < .05). Mean length of hospital stay was also shorter after TEVAR (13.5 vs 16.3 days; P = .30). Independent predictors of patient mortality included age (P = .004) and DTAR (P = .001).

Conclusion: Patients presenting with ACDTA are best treated with TEVAR whenever feasible.

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Source
http://dx.doi.org/10.1001/archsurg.2011.1476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978207PMC
March 2012
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