title: Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques.
abstract: BACKGROUND
  Endovascular repair of thoracic aneurysm has demonstrated low risks of mortality and spinal cord ischemia (SCI), but few large series have been published on endovascular thoracoabdominal aneurysm repair, and reports suffer from a lack of accurate comparison with similar open surgical procedures.
  
  
  RESULTS
  A consecutive cohort of patients with thoracic and thoracoabdominal aneurysms treated electively with endovascular repair (ER) or surgical repair (SR) techniques between 2001 and 2006 were analyzed. The association between repair technique and SCI was evaluated with univariable analysis. Adjustments for potential confounders and for the propensity to receive ER or SR were also performed in multivariable analysis. A total of 724 patients (352 ER, 372 SR) underwent repair. The mean age was 67 years, and 65% were male. ER patients were on average 9 years older (P<0.001), had more comorbid conditions, and more frequently had prior distal repair (P<0.001) or underwent a type I or IV repair. SR patients more commonly had chronic dissection or required type II or type III repairs (P<0.001). Mortality at 30 days (5.7% ER versus 8.3% SR, P=0.2) and 12 months (15.6% ER versus 15.9% SR, P=0.9) was similar. A borderline difference in SCI was found between repair techniques: 4.3% of ER and 7.5% of SR patients (P=0.08) had SCI. In patients with ER, prior distal aortic operation was associated with the development of SCI in univariable analysis (odds ratio 4.1, 95% confidence interval 1.4 to 11.7). Multivariable analysis showed that the type of required repair (type I, II, III, or IV) was the primary factor associated with the development of SCI in ER and SR patients.
  
  
  CONCLUSIONS
  No significant difference in the incidence of mortality or SCI was found between ER and SR techniques. The strongest factor associated with SCI remains the extent of the disease. Further studies are indicated to compare ER with patients considered eligible for SR.
authors.affiliation: Cleveland Clinic, 9500 Euclid Ave, Desk S40, Cleveland, OH 44195, USA. greenbr@ccf.org
authors.forename: Roy K
authors.initials: RK
authors.lastname: Greenberg
authors.forename: Qingsheng
authors.initials: Q
authors.lastname: Lu
authors.forename: Eric E
authors.initials: EE
authors.lastname: Roselli
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Moon
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Hernandez
authors.forename: Joseph
authors.initials: J
authors.lastname: Dowdall
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cury
authors.forename: Catherine
authors.initials: C
authors.lastname: Francis
authors.forename: Kathryn
authors.initials: K
authors.lastname: Pfaff
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Clair
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ouriel
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000209:etiology; D015996:Survival Rate