Results of thoracic endovascular aortic repair 6 years after United States Food and Drug Administration approval

Abstract

Background: Since United States Food and Drug Administration approval in 2005, the short-term safety and efficacy of thoracic endovascular aortic repair (TEVAR) have been established. However, longer-term follow-up data remain lacking. The objective of this study is to report 6-year outcomes of TEVAR in clinical practice.

Methods: A prospective cohort review was performed of all patients undergoing TEVAR at a single referral institution between March 2005 and May 2011. Rates of reintervention were noted. Overall and aortic-specific survival were determined using Kaplan-Meier methods. Log-rank tests were used to compare survival between groups.

Results: During the study interval, 332 TEVAR procedures were performed in 297 patients. Reintervention was required after 12% of procedures at a mean of 8 ± 14 months after initial TEVAR and was higher in the initial tercile of patients (15.0% vs 9.9%). The 6-year freedom from reintervention was 84%. Type I endoleak was the most common cause of reintervention (5%). Six-year overall survival was 54%, and aorta-specific survival was 92%. Long-term survival was significantly lower than that of an age- and sex-matched United States population (p < 0.001). Survival was similar between patients requiring a reintervention vs those not (p = 0.26). Survival was different based on indication for TEVAR (p = 0.007), and patients with degenerative aneurysms had the lowest survival (47% at 6 years). Cardiopulmonary pathologies were the most common cause of death (27 of 93 total deaths).

Conclusions: Long-term aortic-related survival after TEVAR is high, and the need for reintervention is infrequent. However, overall long-term survival is low, particularly for patients with degenerative aneurysms, and additional work is needed to identify patients unlikely to derive a survival benefit from TEVAR.

Fig 1

Kaplan-Meier curve demonstrates an 84% freedom from reintervention at 6 years after thoracic endovascular aortic repair.

Fig 2

Kaplan-Meier curve demonstrates a 54% overall (solid line) and 92% aorta-specific survival (dashed line) after thoracic endovascular aortic repair.

Fig 3

Kaplan-Meier curve demonstrates survival after thoracic endovascular aortic repair according to those who did (solid line) and did not (dashed line) need aortic reintervention.

Fig 4

Kaplan-Meier curve demonstrates survival after thoracic endovascular aortic repair based on indication for procedure. Six-year survival for patients with degenerative aneurysms (solid line) was 47% compared with 60% for patients with acute or chronic dissection (dashed line) and 100% for patients with acute blunt aortic injury (dotted-dashed line).