Treatment of Focal Aortic Disease by Thoracic Endovascular Aortic Repair Is Associated With High Success and Low Morbidity and Mortality

Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for patients with thoracic aortic dissection, aneurysm, or traumatic pseudoaneurysm. However, TEVAR is poorly studied for the treatment of less common aortic pathologies, such as penetrating aortic ulcer (PAU), intramural hematoma (IMH), and pseudoaneurysm (PSA). The purpose of this study was to review the use of TEVAR in the treatment of patients with focal aortic lesions. This was a retrospective analysis of a 10-year TEVAR series at a high-volume aortic referral center. Patients with traumatic aortic injury were excluded. Patients undergoing endovascular repair of focal aortic disease (PAU, IMH, or PSA) were compared with patients with nonfocal disease (dissection or nontraumatic aneurysm). The primary outcome was inpatient mortality, and secondary outcomes were morbidity and resource use. Groups were compared by χ2 or Student t-tests as appropriate, with a P < .05 accepted as significant. A total of 135 patients had TEVAR, with 100% technical success. Fifty had focal aortic disease, including 16 PAU, 11 PSA, and 5 IMH; 18 patients had multiple lesions, primarily PAU with IMH. Eighty-five patients had dissection (n = 48) or aneurysm (n = 37). Patient groups had similar demographics, but those with focal disease were more likely to have acute aortic syndrome (Table). The most common symptoms in both groups were chest or back pain (overall 42% and 18%, respectively). Comorbidities were similar, except for more end-stage renal disease among patients with nonfocal pathologies. There were similar rates of postoperative neurologic deficits, but patients with focal lesions had a trend toward shorter duration of mechanical ventilation. Overall mortality was 6%, and was significantly lower for patients with focal aortic lesions (0% vs 9%; P = .03). Although they are less common than aortic dissection or rupture, focal aortic lesions represent a common indication for TEVAR at an aortic referral center and often present with acute aortic syndrome. TEVAR is highly effective for focal aortic disease and can be performed in this context with an acceptable risk profile. Future study should determine long-term outcomes and aortic remodeling after TEVAR for focal aortic lesions.TablePatient characteristics and outcomesCharacteristicFocal lesions (n = 50)Nonfocal lesions (n = 85)PAge, years ± SD69 ± 1464 ± 15.08Acute aortic syndrome, No. (%)55 (65)47 (94).0001End-stage renal disease, No. (%)4 (6)30 (35).0001Hypertension, No. (%)40 (80)76 (89).20Diabetes, No. (%)9 (18)10 (12).31Neurologic deficit, No. (%)2 (4)11 (13).13Ventilator days, median (IQR)0 (0-1)9 (5-13).06Hospital length of stay, median (IQR)0 (0-3)9 (5-18).43Inpatient mortality, median (IQR)08 (9).03IQR, Interquartile range; SD, standard deviation. Open table in a new tab