Long-Term Experience of Endovascular Repair for Thoracic Aortic Aneurysms and Dissections.
OBJECTIVE
To report the long-term results of thoracic endovascular aortic repair (TEVAR) in both elective and emergency cases of thoracic aortic aneurysm (TAA) and type B dissection.


METHODS
A prospective single-center study of 78 TEVAR patients treated between February 1998 and February 2013. Stent-graft implantation was performed in 51 (65%) patients for TAA (43 elective and 8 emergency cases) and in 27 (35%) patients for type B dissection (11 elective and 16 emergency cases). Short- and long-term results were evaluated, and a subgroup of patients with left subclavian artery (LSA) coverage was also analyzed.


RESULTS
The patients were followed for a mean of 55 months (1-160 months). The technical success rate was 81% and 30-day mortality 6.4% (n = 5). The stroke rate was 7.7% (n = 6) and permanent paraparesis 2.6% (n = 2). In follow-up, there were 28 (36%) primary (15 type I and 13 type II) and 10 secondary endoleaks (8 type I and 2 type II). Multivariate analysis showed no significant predictive factors for developing a type I endoleak. Secondary interventions were required in 24% of the patients. There was 1 late thoracic aortic rupture and 1 late conversion (1.3%). Patients with LSA coverage had a higher incidence of stroke (12.5% vs 4.3%, P = .18) and paraparesis (3.1% vs 2.2%, P = .79) compared to those without LSA coverage, although this difference was not statistically significant. Stroke rates were significantly higher in patients treated in an emergency setting (P = .048).


CONCLUSIONS
Thoracic endovascular aortic repair is a relatively safe and effective therapy for different aortic pathologies with good long-term success. The risk of stroke and paraparesis is notable whether the LSA is covered, and strokes clearly accumulate in the emergency setting. A type I endoleak is the most common complication, but there are no predictive factors for its development.
Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland School of Medicine, University of Tampere, Tampere, Finland Seinäjoki Central Hospital, Seinäjoki, Finland suvi.vaaramaki@pshp.fi.
Suvi
S
Väärämäki
Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland School of Medicine, University of Tampere, Tampere, Finland.
Velipekka
V
Suominen
Department of Radiology, Division of Interventional Radiology, Tampere University Hospital, Tampere, Finland.
Georg
G
Pimenoff
Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland School of Medicine, University of Tampere, Tampere, Finland.
Jukka
J
Saarinen
Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland.
Ilkka
I
Uurto
Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland School of Medicine, University of Tampere, Tampere, Finland.
Juha
J
Salenius
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005387:Finland; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
TAA; TEVAR; long-term results; type B dissection