Endovascular repair of thoracic and thoraco-abdominal aortic lesions

Aims We report our experience of endovascular repair of either thoracic or thoraco-abdominal aortic lesions in patients treated from May 2002 to May 2015. Methods Data of all consecutive treated patients were retrospectively collected from medical records, and patients’ radiological imaging; follow-up was obtained through outpatient visits and telephone interview. All collected data were inserted in a database and analyzed as appropriate, using the software JMP 5.1.2 (SAS Institute). Primary outcomes were mortality, reinterventions and occurrence of neurological complications, both at 30 days and in the long term. Secondary outcomes were the occurrence of post-implantation syndrome and of left arm ischemia in patients in whom the left subclavian artery was intraoperatively covered by the endograft without elective revascularization. P values <.05 were considered statistically significant. Results A total of 94 patients (74 males, 78.7%, median age 73 years, IQR 68-79 years) were treated for either a thoracic or a thoraco-abdominal lesion, being mostly thoracic aortic aneurysms (n=63, 66.9%). Technical success was achieved in 96.8% of the procedures. At 30 days we observed 5 deaths (5.3%) and 5 cases of neurological complications (5.3%, being 2 cases of major stroke,2 cases of transient spinal cord ischemia and one persistent spinal cord ischemia). A reintervention was necessary in 6 patients (6.4%). At 5 years, survival was 62.8%+6.3%, which was significantly affected by age (P=.004), history of renal failure (P=.005) and history of coronary artery disease (P=.02).Freedom from reintervention was 79.7%+4.6% at 1 years and 54.7%+7.6% at 5 years. The main cause for reintervention was a type I endoleak. Freedom from neurological complication (being none of them new paraplegia) was 94.5%+2.4% at 1 years and 88.3%+4.2% at 5 years. A postoperative fever was recorded within 30 days in 37 patients without any sign of infection and no raise of white blood cells count. A left arm ischemia occurred in 4 patients out of 14 in whom the left subclavian artery was covered by the endograft without previous revascularization (P=.0001). Conclusions In our experience, the endovascular repair of either thoracic or thoraco-abdominal aortic lesions was a safe and effective technique, with acceptable mortality and neurological complication rates, both at 30 days and in the long term. Mortality was significantly affected by age and a history of either renal failure or coronary artery disease. Reintervention in the long term were mainly required for a type I endoleak. A post-implantation syndrome was not clearly detected. Coverage of the left subclavian artery significantly affected the occurrence of left arm ischemia.