Department of Vascular and Endovascular Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
J Vasc Surg. 2024 Nov;80(5):1408-1417.e3. doi: 10.1016/j.jvs.2024.07.087. Epub 2024 Jul 26.
Several studies have reported short- and intermediate-term outcomes after thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (DTAA); however, reports on long-term (10 years) outcomes are sparse. Therefore, the aim of this study was to analyze predictors impacting long-term outcome after TEVAR for DTAA.
Databases from four academic institutions were reviewed and consecutive cases of TEVAR for DTAA between 1999 and 2021 were included in this retrospective multicenter study (case series). Ethical approval from the institutional review board was obtained and patient demographics and treatment data, as well as follow-up information were retrieved and analyzed.
We identified 305 patients (mean age, 72 ± 10 years) who were treated with TEVAR for degenerative DTAA with a mean aortic diameter of 64 mm. Altogether 445 endografts were implanted via femoral access (93%) with a technical success of 94%. Operative mortality, stroke rate, and rate of spinal cord ischemia were 6% (5% for intact, 12% for ruptured DTAA), 4%, and 3%, respectively. Kaplan-Meier estimates for overall survival rates were 76%, 59% and 34% at 1, 5 and 10 years and freedom from reintervention rates were 84%, 73% and 58% at 1, 5 and 10 years, respectively. In multivariate analysis, American Society of Anesthesiologists grade 3 to 5 and nonelective case were identified as predictors for death, whereas as fusiform DTAA, proximal landing zone 2, and hypertension, but not device generation, were predictive for reintervention.
This study is, to date, the largest reporting long-term (10 years) outcome on TEVAR for DTAA. We found acceptable rates for long-term survival and freedom from reintervention that were independent of endovascular device generation.
已有多项研究报道了胸主动脉腔内修复术（TEVAR）治疗降主动脉瘤（DTAA）的短期和中期结果；然而，关于长期（10 年）结果的报道却很少。因此，本研究旨在分析影响 DTAA 的 TEVAR 长期结果的预测因素。
本回顾性多中心研究（病例系列）纳入了 1999 年至 2021 年间在四个学术机构的数据库中连续接受 TEVAR 治疗的 DTAA 患者。获得了机构审查委员会的伦理批准，并检索和分析了患者的人口统计学和治疗数据以及随访信息。
我们共纳入了 305 例（平均年龄 72±10 岁）接受 TEVAR 治疗退行性 DTAA 的患者，平均主动脉直径为 64mm。总共通过股动脉入路植入 445 个覆膜支架（93%），技术成功率为 94%。手术死亡率、卒中率和脊髓缺血率分别为 6%（完整 DTAA 为 5%，破裂 DTAA 为 12%）、4%和 3%。Kaplan-Meier 估计总体生存率分别为 1、5 和 10 年时的 76%、59%和 34%，再干预率分别为 1、5 和 10 年时的 84%、73%和 58%。多变量分析显示，美国麻醉医师学会（ASA）分级 3-5 级和非择期手术是死亡的预测因素，而梭形 DTAA、近端锚定区 2 区和高血压是再干预的预测因素，但与血管内装置的类型无关。
这是迄今为止报道 TEVAR 治疗 DTAA 最长（10 年）期结果的最大研究。我们发现长期生存和免于再干预的比率是可以接受的，并且与血管内装置的类型无关。
