title: Emergent repair of acute thoracic aortic catastrophes: a comparative analysis.
abstract: OBJECTIVE
  To provide a contemporary institutional comparative analysis of expedient correction of acute catastrophes of the descending thoracic aorta (ACDTA) by traditional direct thoracic aortic repair (DTAR) or thoracic endovascular aortic repair (TEVAR).
  
  
  METHODS
  Single-center retrospective review (April 2001-January 2010).
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  One hundred patients with ACDTA treated with either TEVAR (n = 76) or DTAR (n = 24). Indications for repair included ruptured degenerative aneurysm (n = 41), traumatic transection (n = 27), complicated acute type B dissection (n = 20), penetrating ulcer (n = 4), intramural hematoma (n = 3), penetrating injury (n = 3), and embolizing lesion (n = 2).
  
  
  METHODS
  Demographics and 30-day and late outcomes were analyzed using multivariate analysis over a mean follow-up of 33.8 months.
  
  
  RESULTS
  Among the 100 patients, mean (SD) age was 58.5 (17.3) years (range, 18-87 years). Demographics and comorbid conditions were similar between the 2 groups, except more patients in the DTAR group had prior aortic surgery (P = .02) and were older (P = .01). Overall 30-day mortality was significantly better among the TEVAR group (8% vs 29%; P = .007). Incidence of postoperative myocardial infarction, acute renal failure, stroke, and paraplegia/paresis was similar between the 2 treatment groups (TEVAR, 5%, 12%, 8%, and 8% vs DTAR, 13%, 13%, 9%, and 13%, respectively). Major respiratory complications were lower in the TEVAR group (16% vs 48%; P < .05). Mean length of hospital stay was also shorter after TEVAR (13.5 vs 16.3 days; P = .30). Independent predictors of patient mortality included age (P = .004) and DTAR (P = .001).
  
  
  CONCLUSIONS
  Patients presenting with ACDTA are best treated with TEVAR whenever feasible.
authors.affiliation: Division of Vascular Surgery, Northwestern University, 676 N St Clair, Ste 650, Chicago, IL 60611, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Naughton
authors.forename: Michael S
authors.initials: MS
authors.lastname: Park
authors.forename: Mark D
authors.initials: MD
authors.lastname: Morasch
authors.forename: Heron E
authors.initials: HE
authors.lastname: Rodriguez
authors.forename: Manuel
authors.initials: M
authors.lastname: Garcia-Toca
authors.forename: C Edward
authors.initials: CE
authors.lastname: Wang
authors.forename: Mark K
authors.initials: MK
authors.lastname: Eskandari
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome