title: Complicated Acute Aortic Syndromes Affecting the Descending Thoracic Aorta: Endovascular Treatment Compared With Open Repair.
abstract: BACKGROUND
  For patients with complicated acute thoracic aortic syndromes, endovascular treatment, when feasible, is preferred over open surgery. However, there are limited data on the long-term benefits of endovascular treatment in complicated acute aortic syndromes affecting the descending thoracic aorta.
  
  
  OBJECTIVE
  The endovascular treatment is expected to have more favorable long-term mortality and fewer late reintervention in complicated acute thoracic aortic syndromes.
  
  
  METHODS
  Of 155 consecutive patients with acute aortic syndromes, 94 met the inclusion criteria of the study; 63 underwent endovascular repair (group 1) and 31 underwent open repair (group 2). Patients with a diagnosis of acute aortic syndrome localized in the descending thoracic aorta distal to the emergence of the left subclavian artery, complicated by rupture, malperfusion syndrome, and/or acute aortic expansion, were included. Indications for repair of the descending thoracic aorta included impending rupture in 70.2%, malperfusion syndrome in 29.8%, and persistence of pain with aortic expansion (aortic diameter >40 mm) in 2 patients.
  
  
  RESULTS
  During the follow-up period (63.0 ± 24.6 months), the cumulative survival free from cardiovascular death rates at 5 years was 92.0% and 51.4% in group 1 and 2, respectively (log rank P = 0.0001). Late mortality related to the aorta was 1.6% with thoracic endovascular aortic repair and 0% with surgical treatment.
  
  
  CONCLUSIONS
  Endovascular treatment in patients with complicated acute thoracic aortic syndromes localized at the descending thoracic aorta is feasible and safe, with a lower rate of early complications and similar long-term benefits when compared with surgical treatment.
authors.affiliation: Department of Interventional Cardiology, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Guering
authors.initials: G
authors.lastname: Eid-Lidt
authors.affiliation: Department of Interventional Cardiology, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gaspar Hernández
authors.affiliation: Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Hector
authors.initials: H
authors.lastname: González-Pacheco
authors.affiliation: Department of Interventional Cardiology, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Acevedo Gómez
authors.affiliation: Department of Cardiovascular Surgery, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ramírez Marroquín
authors.affiliation: Department of Cardiovascular Surgery, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Valentín
authors.initials: V
authors.lastname: Herrera Alarcon
authors.affiliation: Department of Cardiovascular Surgery, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cervantes Salazar
authors.affiliation: General Director, National Institute of Cardiology "Ignacio Chávez,", Mexico City, Mexico.
authors.forename: Marco
authors.initials: M
authors.lastname: Martínez-Ríos
mesh_terms: D000208:Acute Disease; D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013577:Syndrome; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome