Descending Thoracic Aortic Diameter Is a Predictor of Poor Outcome After Endovascular Aortic Repair

Objectives To evaluate the results of thoracic endovascular aortic repair (TEVAR) in large (diameter ≥7 cm) aneurysms of the descending thoracic aorta. Methods This cohort has been extrapolated from the prospective, observational (on-label and off-label), worldwide multicentre Global Registry for Endovascular Aortic Treatment (GREAT) (NCT01658787). Patients were divided into 2 groups based on the baseline aortic diameter: standard aneurysms (<7 cm) and larger aneurysms (≥7 cm). Primary outcomes were overall survival and freedom from TEVAR-related reintervention. Secondary outcomes were freedom from aortic-related mortality (ARM), as well as from type 1 endoleaks, and cumulative risk of TEVAR-related infection and/or aorto-bronchial/oesophageal fistulization. Results We analysed 613 (80.4%) patients with standard aneurysms and 149 (19.6%) with larger aneurysms. Demographic data and comorbidities were not different between the groups. At the 4- to 6-year window, 496 (65.1%) patients remained under follow-up (standard, n = 409 [66.7%] vs large, n = 87 [58.4%]; odds ratio [OR]: 1.4, P =.056). Large aneurysm diameter was independently associated with higher hazards for all-cause mortality (hazard ratio [HR]: 1.6, 95% CI, 1.19-2.20; P <.001), TEVAR-related reintervention (HR: 2.4, 95% CI, 1.52-3.65; P <.001), risk of ARM (HR: 2.2, 95% CI, 1.03-4.75; P =.026), cumulative risk of TEVAR-related infection/fistulization, and type 1 endoleaks (HR: 3.3, 95% CI, 1.89-5.65; P <.001). Conclusions Preoperative descending thoracic aortic diameter seems to be an important determinant of outcomes after TEVAR, where patients presenting with aortic diameter ≤ 7 cm showed more favourable long-term outcomes.