title: Outcomes of endovascular repair of ruptured descending thoracic aortic aneurysms.
abstract: BACKGROUND
  Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors that affect these outcomes.
  
  
  RESULTS
  We retrospectively investigated the outcomes of 87 patients who underwent thoracic endovascular aortic repair for rDTAA at 7 referral centers between 2002 and 2009. The mean age was 69.8+/-12 years and 69.0% of the patients were men. Hypovolemic shock was present in 21.8% of patients, and 40.2% were hemodynamically unstable. The 30-day mortality rate was 18.4%, and hypovolemic shock (odds ratio 4.75; 95% confidence interval, 1.37 to 16.5; P=0.014) and hemothorax at admission (odds ratio 6.65; 95% confidence interval, 1.64 to 27.1; P=0.008) were associated with increased 30-day mortality after adjusting for age. Stroke and paraplegia occurred each in 8.0%, and endoleak was diagnosed in 18.4% of patients within the first 30 days after thoracic endovascular aortic repair. Four additional patients died as a result of procedure-related complications during a median follow-up of 13 months; the estimated aneurysm-related mortality at 4 years was 25.4%.
  
  
  CONCLUSIONS
  Endovascular repair of rDTAA is associated with encouraging results. The endovascular approach was associated with considerable rates of neurological complications and procedure-related complications such as endoleak.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Frederik H W
authors.initials: FH
authors.lastname: Jonker
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
authors.forename: Robin H
authors.initials: RH
authors.lastname: Heijmen
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: W Anthony
authors.initials: WA
authors.lastname: Lee
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.forename: Husam
authors.initials: H
authors.lastname: Athamneh
authors.forename: Bart E
authors.initials: BE
authors.lastname: Muhs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome