Endovascular treatment for nontraumatic rupture of the descending thoracic aorta: long-term results.
BACKGROUND
This study evaluated the long-term results of thoracic endovascular aortic repair (TEVAR) of nontraumatic rupture of the descending thoracic aorta.


METHODS
This was a retrospective and observational single-center study. During the 10-year study period, 21 patients (6 males) with an average age of 66.1 ± 12.4 (range 31-81) years underwent emergency TEVAR for nontraumatic rupture of the descending thoracic aorta. The underlying aortic pathologies causing the rupture were degenerative aneurysms in 11 patients, complicated type B dissection in nine, and erosion hemorrhage due to neoplasia in one patient.


RESULTS
The 30-day mortality rate was 9.5% (2/21). Two patients died postoperatively: one from a repeat aortic rupture and the other from pneumonia. Two patients underwent early endovascular reintervention. After a median follow-up of 65.6 ± 50.4 (range 1.5-44) months, 10 patients died, resulting in a late mortality of 52.6% (10/19). Six patients (31.5%) developed major complications requiring late reintervention. There was no mortality with reintervention.


CONCLUSIONS
Endovascular treatment of the descending thoracic aorta in patients with nontraumatic rupture is a promising treatment option in an emergency setting with a relatively low mortality rate. Despite encouraging early results, TEVAR is associated with a high reintervention rate and poor survival due to nonaortic or procedure-related mortality in the long term.
Department of Thoracic- and Cardiovascular Surgery, St.-Johannes Hospital Dortmund, Dortmund, Germany; Faculty of Health, University Witten/Herdecke, Witten, Germany.
Spiridon
S
Botsios
Johannes
J
Frömke
Gerhard
G
Walterbusch
Karl
K
Schuermann
Jan
J
Reinstadler
Guido
G
Dohmen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery*; D004630:Emergencies; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013997:Time Factors; D016896:Treatment Outcome