title: A 20-year experience with thoracic endovascular aortic repair.
abstract: BACKGROUND
  Endovascular approaches (thoracic endovascular aortic repair) have revolutionized treatment of thoracic aortic disease.
  
  
  OBJECTIVE
  We report our 20-year experience with this therapy.
  
  
  METHODS
  Four hundred twenty patients (mean age = 69.0 years; 54% male) underwent thoracic endovascular aortic repair (1993-2013), predominantly for fusiform aneurysm (n = 144), saccular aneurysm (n = 94), acute (n = 64) or chronic (n = 36) dissection, or traumatic injury (n = 39). Rupture was present in 80 patients (19.1%). Most patients (78.3%) were at high risk for open repair. Mean aortic diameter was 5.5 cm. Extent of repair included arch in 218 patients, total descending aorta in 193 patients, and thoracoabdominal aorta in 35 patients.
  
  
  RESULTS
  Thirty-day mortality occurred in 20 patients (4.8%). Neurologic events included stroke (5.0%) and spinal cord ischemia (permanent 1.7%, temporary 7.9%). Although dialysis was only required in 1.4% of the patients, 19% had renal failure by RIFLE (Risk, Injury, Failure) criteria. Endoleak occurred in 32.9% of the patients. Ten-year freedom from dissection, rupture, or need for reintervention in treated or adjacent aortic segments (ie, treatment failure) was 63.2%. Independent predictors included presentation with rupture, preexisting renal failure, or intervention on the arch aorta (all Ps < 0.03). Aortic pathology also independently predicted treatment failure (P = 0.026). The 15-year survival rate was 32.3%. Advancing age, presence of coronary artery disease, rupture, or postoperative renal failure (all Ps < 0.05), but not treatment failure (P = 0.926), independently predicted late mortality.
  
  
  CONCLUSIONS
  Thoracic endovascular aortic repair can be performed with acceptable results in a high-risk population. The risk of treatment failure persists, underscoring the importance of continued long-term endograft surveillance, but this does not seem to impact late mortality.
authors.affiliation: Departments of *Cardiac Surgery †Radiology, and ‡Section of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor.
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Drews
authors.forename: Narasimham L
authors.initials: NL
authors.lastname: Dasika
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.forename: Mary C
authors.initials: MC
authors.lastname: Passow
authors.forename: G Michael
authors.initials: GM
authors.lastname: Deeb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D014949:Wounds, Nonpenetrating / Q000601:surgery