title: Thoracic endovascular aortic repair: A single center's 15-year experience.
abstract: OBJECTIVE
  Specific complications of thoracic endovascular aortic repair (TEVAR) exist and long-term data are lacking. The purpose of this study was to evaluate our long-term TEVAR results.
  
  
  METHODS
  This is a single-center retrospective study of 223 patients undergoing TEVAR from 1998 to 2013. Indication was aneurysm (45%), traumatic (26%), dissection (23%), and septic (6%).
  
  
  RESULTS
  Patients' mean age was 62.7 ± 17.9 years, 84% of them had an American Society of Anesthesiologists score ≥3, and 42% had an aortic rupture. TEVAR was performed in zone 0 (n = 17), 1 (n = 17), or 2 (n = 59) in 42% of patients. Technical success rate was 96.4%. Overall 30-day mortality was 11.7% (elective aneurysm, 11.6%; emergent aneurysm, 34.3%; acute type B dissection, 14.8%; chronic dissection, 4.2%; septic, 8.3%; and traumatic, 1.7%). Major adverse events included stroke in 4.5%, spinal cord ischemia in 1.8%, and retrograde aortic dissection in 2.7%. Mean follow-up was 43.4 ± 38 months. Estimated aortic complications-free survivals at 12, 36, 60, and 120 months were (% ± standard error) 73% ± 3%, 64% ± 4%, 62% ± 4% and 57% ± 5%, respectively. Multivariate analysis showed that patients treated for a chronic aortic dissection had a significant risk of late reintervention (P = .001) CONCLUSIONS: Because of its simplicity and low morbimortality rate, TEVAR has become the first-line approach for thoracic aortic diseases. Mortality outcomes are related to aortic pathology, emergent status, and proximal landing zone. To improve long-term results, rigorous patient selection and follow-up, development of referral centers, and technologic evolution of materials have to be reached.
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France. Electronic address: vziza@club.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ziza
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Department of Clinical Research and Epidemiology, Arnaud de Villeneuve University Hospital, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Branchereau
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-Ané
authors.affiliation: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: TEVAR; aorta; aortic arch; endovascular; stent-graft