A comparative analysis of open and endovascular repair for the ruptured descending thoracic aorta

A Kaplan-Meier survival analysis comparing open descending thoracic aortic repair to thoracic aortic endovascular repair. This actuarial analysis demonstrates that following either open or endovascular thoracic aortic repair, there is no significant difference in Kaplan-Meier survival for patients presenting with descending aortic rupture. The 10-year survival for TEVAR is 21.3% vs that for DTAR at 30.8% (log rank P = .72). The survival curves have been truncated at seven years, where the standard error exceeds 10%.

A Kaplan-Meier analysis describing the need for reintervention in any aortic segment. This analysis suggests that the need for aortic reintervention at any aortic segment (treated, adjacent, or remote) is significantly higher in the TEVAR group. Freedom from reintervention at four years was 87.4% for DTAR vs 61.2% for TEVAR (P = .037). In this analysis, if patients were deemed to be nonoperative, or refused further intervention, the date at which point the need for reintervention was identified was used as the time of treatment failure.

The evolution of therapy for descending aortic rupture at the University of Michigan. This graph divides the entire TEVAR era at the University of Michigan into three time periods. The years 1993-1999 reflect the time when no commercial endografts were generally available, and the dominant procedure is open aortic repair. During the years 2000-2004, endografts were typically available as part of clinical trials, although we did selectively utilize custom-fabricated devices. Finally, 2005-2008 reflects the time period when thoracic endografts were commercially available. This graph demonstrates an increasing shift toward endovascular repair during the study period, likely reflecting the ability to now offer a therapeutic option to patients previously considered non-operative candidates (ie, previously referred to medical therapy alone). Note, however, during this period, open repair is still considered an important option during this period, representing the primary mode of therapy for patients considered suitable candidates for open repair.