Endovascular repair of ruptured thoracic aortic aneurysms is associated with high perioperative mortality and morbidity.
OBJECTIVE
To analyze early and midterm results after endovascular treatment of ruptured thoracic aortic aneurysms (rTAA).


METHODS
Between January 1997 and January 2009, a total of 236 patients received thoracic aortic repair in our institution; 23 patients (14 men; median age, 75 years; range, 60-88 years) due to a ruptured thoracic aortic aneurysm (rTAA). Rupture was defined according to computed tomography angiography (CTA) criteria with definite sign for hemorrhage outside the aortic wall. Patients with symptomatic TAA but with normal CT scans were excluded. A retrospective analysis of these patients was performed. Median follow up was 28 months (range, 0.1-82.5 months) and included serial aortic imaging at discharge, six, and 12 months and annually thereafter.


RESULTS
Technical success rate was 87%. The overall in hospital mortality was 48% with predominantly (50%) cardiac complications. Neurological complications occurred in three patients, two patients suffered from a transient ischemic attack (TIA)/stroke, and one patient experienced paraplegia after early conversion to open surgery. Primary endoleaks were seen in four of 25 patients (16%); no secondary endoleak was observed. Early conversion was necessary in two patients caused by an aortoesophageal fistula. The one- and three-year survival rates were 37.3% and 29.9% with no aortic or procedure-related death during follow up. Reintervention was necessary in four of 25 patients (16%). Cox regression analysis revealed preoperative renal insufficiency (hazard ratio [HR] 5.85, P = .0073) as an independent predictor of perioperative death.


CONCLUSIONS
The endovascular treatment of ruptured thoracic aortic aneurysms is associated with a high perioperative mortality and morbidity as well as poor midterm survival. Renal insufficiency proved to be an independent risk factor for perioperative death.
Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany. Philipp.Geisbuesch@med.uni-heidelberg.de
Philipp
P
Geisbüsch
Drosos
D
Kotelis
Tim F
TF
Weber
Alexander
A
Hyhlik-Dürr
Dittmar
D
Böckler
D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome