title: Initial results of a thoracic aortic endovascular program: safer in high-risk patients.
abstract: Results are presented from our single-institutional experience with thoracic endovascular aortic repair to confirm that it is safe in patients with significant comorbidities. A retrospective review of all patients undergoing endovascular or open thoracic aortic repair at our institution since 2002 was performed. Main outcome measures included clinical presentation, demographics, preoperative risk factors, operative details, and clinical outcomes. The endovascular group included 37 patients (22 males), whereas the open group included 19 patients (eight males). Eight patients per group were treated emergently for trauma or rupture (22% and 42%, respectively; p=0.11). Endovascular patients were significantly older with more comorbid conditions (p<0.05). However, the overall perioperative complication rate was similar in the two groups (32.4% and 31.6%, respectively). Postoperative renal failure occurred only in four open patients (21.1% vs. 0%, p < 0.05). Operative time, ventilator days, and total length of stay were also greater for open patients (p<0.05). There was one death in the endovascular group and three in the open group (2.7% and 15.8%, respectively; p=0.07). Endovascular patients had shorter operative time and length of stay, fewer ventilator days and intensive care unit days, and fewer transfusions. Although the endovascular patients were significantly older with more comorbidities, the complication rate was similar to the open group. Also, there was a trend toward lower mortality in the endovascular group (p=0.07). Endovascular repair is the procedure of choice for treating the descending thoracic aorta in high-risk patients even in the emergent setting.
authors.affiliation: Michigan State University/Grand Rapids Medical Education and Research Centre/General Surgery Residency, Grand Rapids, MI, USA. chadwick.stouffer@surgery.ufl.edu
authors.forename: Chadwick W
authors.initials: CW
authors.lastname: Stouffer
authors.forename: M Ashraf
authors.initials: MA
authors.lastname: Mansour
authors.forename: Mickey M
authors.initials: MM
authors.lastname: Ott
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hooker
authors.forename: Jill M
authors.initials: JM
authors.lastname: Gorsuch
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cuff
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
mesh_terms: D000328:Adult; D000367:Age Factors; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D015897:Comorbidity; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D015397:Program Evaluation; D051437:Renal Insufficiency / Q000209:etiology; D012092:Replantation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality