title: Pathology specific early outcome after thoracic endovascular aortic repair.
abstract: OBJECTIVE
  Endovascular intervention is established for treatment of thoracic aortic dissection and aneurysm. The aim of this study was to compare the incidence of all-cause and aortic-related in-hospital mortality, stroke, spinal cord ischaemia, and major adverse event rate for patients undergoing thoracic aortic endovascular intervention to see if there is a pathology-specific effect.
  
  
  METHODS
  Data were collected prospectively and analysed retrospectively for a cohort of 309 consecutive patients with either thoracic aortic dissection or aneurysm over a 14-year period.
  
  
  RESULTS
  There were 209 men and 100 women with a median age of 72 years (interquartile range [IQR] 63-78 years). Aneurysm affected 62% (193/309) of patients and 37% (116/309) had complicated type B aortic dissection, of whom 43% (50/116) had acute and 57% (66/116) chronic presentations. In patients with aortic dissection compared to aneurysm, there was no significant difference in all-cause in-hospital mortality (6.9% vs. 8.3% respectively, p = 0.827, relative risk [RR] 0.83, 95% confidence interval [CI] 0.37-1.88), stroke (6.0% vs 6.2%, p = 1.00, RR 0.971, CI 0.39-2.39), spinal cord ischaemia (6.0% vs 6.2%, p = 1.00, RR 1.030, CI 0.42-2.54), or major adverse event rate (16.4% vs. 16.6%, p = 1.00, RR 0.988, CI 0.59-1.66). The rate of aortic related death was four times greater in the dissection than in the aneurysm group (4/8 = 50% vs 2/16 = 12.5%, p = 0.06, RR 6.99, CI 0.92-52.5) although this did not reach statistical significance.
  
  
  CONCLUSIONS
  There was no difference in the incidence of in-hospital mortality, stroke, and spinal cord ischaemia between aneurysm and dissection. The higher rate of aortic related death in the dissection group may indicate the need to refine the clinical management of these patients, including procedural planning, endograft design, and operative technique.
authors: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK. Electronic address: rachel.clough@kcl.ac.uk.
authors: R E
authors: RE
authors: Clough
authors: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK.
authors: A S
authors: AS
authors: Patel
authors: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK.
authors: O T
authors: OT
authors: Lyons
authors: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK.
authors: R E
authors: RE
authors: Bell
authors: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK.
authors: H A
authors: HA
authors: Zayed
authors: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK.
authors: T W
authors: TW
authors: Carrell
authors: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK.
authors: P R
authors: PR
authors: Taylor
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000401:mortality; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome
keywords: Aneurysm; Dissection; Thoracic endovascular aortic repair