title: Pathology-specific secondary aortic interventions after thoracic endovascular aortic repair.
abstract: OBJECTIVE
  Despite improved short-term outcomes, concerns remain regarding durability of thoracic endovascular aortic repair (TEVAR). The purpose of this analysis was to evaluate the pathology-specific incidence of secondary aortic interventions (SAI) after TEVAR and their impact on survival.
  
  
  METHODS
  Retrospective review was performed of all TEVAR procedures and SAI at one institution from 2004-2011. Kaplan-Meier analysis was used to estimate survival.
  
  
  RESULTS
  Of 585 patients, 72 (12%) required SAI at a median of 5.6 months (interquartile range, 1.4-14.2) with 22 (3.7%) requiring multiple SAI. SAI incidence differed significantly by pathology (P = .002) [acute dissection (21.3%), postsurgical (20.0%), chronic dissection (16.7%), degenerative aneurysm (10.8%), traumatic transection (8.1%), penetrating ulcer (1.5%), and other etiologies (14.8%)]. Most common indications after dissection were persistent false lumen flow and proximal/distal extension of disease. For degenerative aneurysms, SAI was performed primarily to treat type I/III endoleaks. SAI patients had a greater mean number of comorbidities (P < .0005), stents placed (P = .0002), and postoperative complications after the index TEVAR (P < .0005) compared with those without SAI. Freedom from SAI at 1 and 5 years (95% confidence interval) was estimated to be 86% (82%-90%) and 68% (57%-76%), respectively. There were no differences in survival (95% confidence interval) between patients requiring SAI and those who did not [SAI 1-year, 88% (77%-93%); 5-year, 51% (37%-63%); and no SAI 1-year, 82% (79%-85%); 5-year, 67% (62%-71%) (log-rank, P = .2)].
  
  
  CONCLUSIONS
  SAI after TEVAR is not uncommon, particularly in patients with dissection, but does not affect long-term survival. Aortic pathology is the most important variable impacting survival and dictated need, timing, and mode of SAI. The varying incidence of SAI by indication underscores the need for diligent surveillance protocols that should be pathology-specific.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla. Electronic address: salvatore.scali@surgery.ufl.edu.
authors.forename: Salvatore T
authors.initials: ST
authors.lastname: Scali
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Beck
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
authors.forename: Khayree
authors.initials: K
authors.lastname: Butler
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Feezor
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla.
authors.forename: Tomas D
authors.initials: TD
authors.lastname: Martin
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Hess
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Huber
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Chang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D015897:Comorbidity; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015995:Prevalence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome