Secondary interventions after elective thoracic endovascular aortic repair for degenerative aneurysms.
OBJECTIVE
We assessed the incidence and outcomes of graft-related secondary interventions (ie, open conversion or proximal or distal extensions) after elective thoracic endovascular aortic repair (TEVAR) for aneurysmal disease.


METHODS
An institutional review of TEVAR for descending thoracic aortic aneurysms (DTAAs), between 2000 and 2011, was performed. Only elective TEVAR for DTAA using commercially available endografts was selected. Emergent cases, nonaneurysmal aortic pathology (ie, transection, pseudoaneurysm, dissection), and cases that used physician-modified devices were excluded. The incidence of unplanned graft-related secondary interventions was examined and outcomes were analyzed.


RESULTS
During the study period, 83 patients underwent elective TEVAR for DTAA that met the inclusion criteria. Subsequent graft-related secondary interventions were required in eight patients (10%). The mean interval to the secondary intervention was 31.8 months. Endoleak was the most common indication. Patients who required secondary interventions were significantly younger (mean age, 58 ± 12 vs 69 ± 11 years; P < .05). Operative mortality (<30 day) was zero, with one aneurysm-related late death occurring at 2 years after the secondary intervention. Factors that predisposed the need for secondary interventions were fusiform morphology of the aneurysm (P = .05) and extent of graft coverage in the proximal landing zone <3 cm (P < .05). Size of the aneurysm treated and the type of device used were not significant factors leading to secondary intervention.


CONCLUSIONS
Intermediate and long-term results of elective TEVAR for DTAA demonstrate good durability, with acceptable rates of graft-related secondary interventions. Age, fusiform aneurysm morphology, and extent of proximal landing zones <3 cm were significant factors that led to subsequent secondary interventions.
Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc, USA.
Cheong J
CJ
Lee
Heron E
HE
Rodriguez
Melina R
MR
Kibbe
S Chris
SC
Malaisrie
Mark K
MK
Eskandari
D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D002641:Chicago / Q000453:epidemiology; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D057867:Endoleak / Q000453:epidemiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome