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. 2022 Jun 15;35(1):ivac042.
doi: 10.1093/icvts/ivac042.

Early and mid-term outcomes of thoracic endovascular aortic repair to treat aortic rupture in patients with aneurysms, dissections and trauma

Julia Benk  1 , Matthias Siepe  1 , Tim Berger  1 , Friedhelm Beyersdorf  1 , Stoyan Kondov  1 , Bartosz Rylski  1 , Martin Czerny  1 , Maximilian Kreibich  1
Affiliations

Early and mid-term outcomes of thoracic endovascular aortic repair to treat aortic rupture in patients with aneurysms, dissections and trauma

Julia Benk et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: The aim of this study was to analyse outcomes of thoracic endovascular aortic repair to treat aortic rupture.

Methods: Patient and outcome characteristics of all emergent endovascular treatments for thoracic aortic rupture between January 2009 and December 2019 were analysed.

Results: Thoracic aortic rupture occurred in patients with aortic aneurysms (n = 42, 49%), aortic dissection (n = 13, 16%) or after trauma (n = 30, 35%). Preoperative cerebrospinal fluid drainage was placed in 9 patients (11%) and 18 patients (21%) underwent perioperative supra-aortic transposition. The proximal landing zones were: zone 1 (n = 1, 1%), zone 2 (n = 23, 27%), zone 3 (n = 52, 61%) and zone 4 (n = 9, 11%). Temporary spinal cord injury occurred in 1 patient (1%), permanent spinal cord injury in 7 patients (8%). Two patients (2%) experienced a postoperative stroke. Seventeen patients (20%) expired in-hospital. Aortic dissection (odds ratio: 16.246, p = 0.001), aneurysm (odds ratio: 9.090, P = 0.003) and preoperative shock (odds ratio: 4.646, P < 0.001) were predictive for mortality. Eighteen patients (21%) required a stent-graft-related aortic reintervention for symptomatic supra-aortic malperfusion (n = 3, 4%), endoleaks (n = 6, 7%), a second aortic rupture (n = 4, 5%), retrograde type A aortic dissection (n = 2, 2%), aortic-oesophageal fistulation (n = 2, 2%) and stent-graft kinking (n = 1, 1%).

Conclusions: Thoracic endovascular aortic repair in patients with aortic rupture has become a valuable treatment modality to stabilize patients. However, a significant risk of postoperative morbidity and mortality remains, particularly in patients with aortic dissections, aneurysms or shock. Patients require thorough follow-up ideally in an aortic clinic with a staff having the entire spectrum of cardiovascular and thoracic surgical expertise.

Keywords: Aneurysms; Aortic dissection; Aortic rupture; Thoracic endovascular aortic repair; Traumatic aortic injury.

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Figures

Figure 1:
Figure 1:
Competing−risks regression for reintervention.
Figure 2:
Figure 2:
Kaplan–Meier curves depicting late survival in patient who were treated with emergent thoracic endovascular aortic repair secondary to an aortic rupture of an aneurysmatic aorta (red), dissected aorta (green) or after thoracic trauma (blue). Log-rank test: P = 0.002.
Figure 3:
Figure 3:
Representative computed tomography angiography scans depicting an aortic rupture (A), a haematothorax caused by an acute aortic rupture (B) and an endoleak type Ia 4 years after emergent thoracic endovascular aortic repair (C).
None
See this image and copyright information in PMC

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