Outcomes of Patients with Descending Aortic Aneurysms Undergoing Thoracic Endovascular Repair in Different Landing Zones

 

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Background: Thoracic endovascular repair (TEVAR) for descending thoracic aneurysms (DTA) with proximal device landing zones (DLZ) in the aortic arch sets additional challenges. The aim of this study was to evaluate outcomes among these patients.

Method: A retrospective analysis of 131 patients treated between 2006 and 2019 at a single center. Aortic and patients characteristics as well as surgical strategies were evaluated.

Results: A total of 131 patients were included. Six patients (4.6%) had a proximal DLZ in zone 0, 3 patients (7.6%) in zone 1, 72 patients (54.9%) in zone 2, and 50 patients (38.2%) in zone 3. Thirty-two patients (24.4%) underwent urgent or emergent TEVAR. 61 patients (46.6%) received carotid–subclavian bypass (CSB), 3 patients had partial debranching, and 5 patients had total debranching. Four patients received a stent graft with scallop or chimney stent for the LSA. The LSA was overstented without revascularization in 7 patients, of whom 5 presented as emergency. Median aneurysm diameter and aneurysm volume were 64 mm and 308 mL, respectively. Median proximal DLZ centerline length and stent oversizing was 28.8 mm (19.6, 47.0) and 20.5% (11.6, 28.7), respectively. Eight patients (6.1%) had type 1a endoleak in the first 2 weeks. Three patients had type 1a endoleak at 13, 14, and 21 months. No paraplegia was occurred. Six patients (8.6%) with CSB or debranching and two patients (3.3%) w/o CSB or debranching developed a postoperative neurological event. Overall survival was 95.4% at 30 days, 54.0% at 5 years, and 27.2% at 10 years, and freedom from reintervention was 91.6% at 30 days and 53.9% at 5 years. Patients with DLZ zone 0–1 had 253% higher risk for long-term mortality (p = 0.002) than patients with DLZ zone 2 or 3. The length of DLZ zone 0, 1 and 2 was significantly longer than zone 3 (p < 0.001). In univariable analysis, postoperative neurological events (p = 0.027), operative urgency (p = 0.002), longer procedure duration (p = 0.044), and higher age (p < 0.001) and EuroSCORE II (p < 0.001) were associated with mortality. In multivariable analysis, procedure duration >3 hours, operative urgency and age >80 years were significantly associated with mortality.

Conclusion: Patients with zone 0–1 as DLZ were at higher risk of mortality and reintervention. Procedure duration was associated with long-term mortality and patients who received debranching tended to have higher rates of neurologic events.

Publication History

Article published online:
03 February 2022

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