Endovascular repair of ruptured thoracic aortic aneurysms is associated with high perioperative mortality and morbidity
Received 22 July 2009; accepted 14 August 2009.
Purpose
To analyze early and midterm results after endovascular treatment of ruptured thoracic aortic aneurysms (rTAA).
Methods
Between January 1997 and January 2009, a total of 236 patients received thoracic aortic repair in our institution; 23 patients (14 men; median age, 75 years; range, 60-88 years) due to a ruptured thoracic aortic aneurysm (rTAA). Rupture was defined according to computed tomography angiograpy (CTA) criteria with definite sign for hemorrhage outside the aortic wall. Patients with symptomatic TAA but with normal CT scans were excluded. A retrospective analysis of these patients was performed. Median follow up was 28 months (range, 0.1-82.5 months) and included serial aortic imaging at discharge, six, and 12 months and annually thereafter.
Results
Technical success rate was 87%. The overall in hospital mortality was 48% with predominantly (50%) cardiac complications. Neurological complications occurred in three patients, two patients suffered from a transient ischemic attack (TIA)/stroke, and one patient experienced paraplegia after early conversion to open surgery. Primary endoleaks were seen in four of 25 patients (16%); no secondary endoleak was observed. Early conversion was necessary in two patients caused by an aortoesophageal fistula. The one- and three-year survival rates were 37.3% and 29.9% with no aortic or procedure-related death during follow up. Reintervention was necessary in four of 25 patients (16%). Cox regression analysis revealed preoperative renal insufficiency (hazard ratio [HR] 5.85, P = .0073) as an independent predictor of perioperative death.
Conclusions
The endovascular treatment of ruptured thoracic aortic aneurysms is associated with a high perioperative mortality and morbidity as well as poor midterm survival. Renal insufficency proved to be an independent risk factor for perioperative death.
aDepartment of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany
bDepartment of Diagnostic and Interventional Radiology, Ruprecht-Karls University, Heidelberg, Germany
Reprint requests: Philipp Geisbüsch, MD, Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
Competition of interest: none.
The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.
ABSTRACT