title: Applicability and mid-term results of endovascular treatment for descending thoracic acute aortic syndromes.
abstract: BACKGROUND
  Descending thoracic acute aortic syndromes (DTAASs) are life-threatening pathologies in which thoracic endovascular aortic repair (TEVAR) is an attractive therapeutic option. There are few data in the literature on the survival and morbidity rates of TEVAR in such indications. We provide the results of TEVAR from our single-center cohort of DTAASs: ruptured aneurysms (RAs), acute symptomatic dissections (ADs), and traumatic ruptures (TRs).
  
  
  METHODS
  Between 2004 and 2011, data from all patients treated by TEVAR for DTAAS in our university center were collected prospectively. Primary end points were rates of 30-day mortality and morbidity. Secondary end points were mid-term outcomes and reinterventions.
  
  
  RESULTS
  Forty-eight patients underwent TEVAR for DTAASs: 19 RAs (39.6%), 12 ADs (25.0%), and 17 TRs (35.4%). The cumulative 30-day mortality and morbidity rate was 33%. There were 10 deaths (6 RAs, 1 AD, and 3 TRs), 2 cases of paraplegia (0 postoperative and 2 preoperative cases (2 TRs), and no major reinterventions and 4 minor reinterventions (embolization for endoleak exclusion). Long-term outcomes were known in 33 patients (5 patients were lost to follow-up), with a mean duration follow-up of 27 months. The cumulative mortality and morbidity rate was 9%: no deaths were reported, and 2 major reinterventions (open aneurysm repair) and 1 minor reintervention (endoleak exclusion) were required.
  
  
  CONCLUSIONS
  Our results confirm that TEVAR, as an emergency therapeutic option, is suited to DTAASs. The 21% perioperative mortality rate for such dramatic lesions remains high but is lower than medical or open repair therapeutic options previously reported. No additional deaths occurred during the 2-year follow-up period, and a low incidence of endograft-related reinterventions was observed. Nevertheless, scheduled follow-up visits with computed tomodensitometry scans on a regular basis are mandatory.
authors.affiliation: Hopital Européen Georges Pompidou, Faculté de Médecine René Descartes, Université Paris 5, Paris, France. Electronic address: Jean-marc.alsac@egp.aphp.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Alsac
authors.forename: Tibault
authors.initials: T
authors.lastname: Pierard
authors.forename: Salma
authors.initials: S
authors.lastname: El Batti
authors.forename: Paul
authors.initials: P
authors.lastname: Achouh
authors.forename: Pierre
authors.initials: P
authors.lastname: Julia
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001015:Aortic Arch Syndromes / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D004621:Embolization, Therapeutic; D004630:Emergencies; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D010297:Paris; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome