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Vol. 45. Issue 5.
Pages 280-288 (June - July 2021)
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Vol. 45. Issue 5.
Pages 280-288 (June - July 2021)
Original
DOI: 10.1016/j.medine.2021.04.008
A multicenter study of emergency endovascular repair of the thoracic aorta: Indications and outcomes
Estudio multicéntrico de la reparación endovascular urgente de la aorta torácica: indicaciones y resultados
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C. López Espadaa,
Corresponding author
clegra3@hotmail.com

Corresponding author.
, J.P. Linares Palominoa, J.M. Domínguez Gonzálezb, E. Iborra Ortegac, P. Lozano Vilardelld, T. Solanich Valldaurae, G. Volo Pérezf, E. Blanco Cañibanog, A. Álvarez Salgadoh, J.C. Fernández Fernándezi, M. Hernando Rydingsj, M. Miralles Hernándezk
a Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, Spain
b Servicio de Cirugía Vascular, Hospital Universitari Vall d’Hebron, Barcelona, Spain
c Servicio de Cirugía Vascular, Hospital Universitari de Bellvitge, Barcelona, Spain
d Servicio de Cirugía Vascular, Hospital Universitari Son Espases, Palma de Mallorca, Spain
e Servicio de Cirugía Vascular, Corporació Sanitaria Parc Tauli, Sabadell, Spain
f Servicio de Cirugía Vascular, Hospital Universitario Dr. Negrín, Gran Canaria, Spain
g Servicio de Cirugía Vascular, Hospital Universitario de Guadalajara, Guadalajara, Spain
h Servicio de Cirugía Vascular, Hospital Universitario de Cabueñes, Spain
i Servicio de Cirugía Vascular, Hospital de Galdakao, Spain
j Servicio de Cirugía Vascular, Hospital Universitario de Basurto, Spain
k Servicio de Cirugía Vascular, Hospital Universitario de La Fe, Valencia, Spain
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Tables (3)
Table 1. Demographic data and risk factors of the study population.
Table 2. Specific data according to the type of disease condition affecting the descending thoracic aorta (DTA).
Table 3. Main outcomes and complications according to the type of disease condition.
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Additional material (1)
Abstract
Objective

Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery.

Study design and scope

A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012–2016, in 11 clinical units.

Patients, inclusion criteria

1) Ruptured descending thoracic aortic aneurysms (RTAA); 2) Blunt traumatic thoracic aortic injury (TAI); and 3) Complicated acute type B aortic dissections (TBADc).

Primary variables

Patient mortality, survival and reoperation rate.

Secondary variables

Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications.

Results

A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the RTAA group (27.9%). The mean actuarial survival rate was 67 ± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%).

Conclusions

Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality — though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.

Keywords:
Thoracic aortic disease
Endograft
Emergency endovascular repair
Aortic dissection
Aortic aneurysm
Mortality
Traumatic aortic rupture
Resumen
Objetivo

Las técnicas endovasculares se han convertido en una herramienta esencial para el tratamiento de la patología de aorta torácica descendente (TEVAR). El objetivo es analizar las indicaciones y resultados del TEVAR urgente a nivel nacional en relación con la cirugía programada.

Diseño y ámbito de estudio

Registro multicéntrico retrospectivo de pacientes con patología de aorta torácica descendente tratados de urgencia mediante técnicas endovasculares entre los años 2012–2016 en 11 servicios clínicos.

Pacientes, criterios de inclusión

1) Aneurismas de aorta torácica rotos (AATR), 2) roturas traumáticas de aorta torácica (TAT) y 3) disecciones de aorta torácica tipo B (DATBc) complicadas.

Variables principales

Mortalidad, supervivencia y tasa de reintervenciones.

Variables secundarias

Datos demográficos, factores de riesgo cardiovasculares, datos específicos por indicación, datos técnicos y complicaciones postoperatorias.

Resultados

Se obtuvieron 135 TEVAR urgentes (111 varones, edad media 60,4 ± 16,3 años): 43 aneurismas aórticos rotos (31,9%), 54 disecciones tipo B (40%) y 32 roturas aórticas traumáticas (23,7%) y otras etiologías 4,4%. La mortalidad global a los 30 días fue del 18,5%, siendo superior en los AATR (27,9%). La supervivencia media actuarial ha sido del 67 ± 6% a los 5 años. La tasa de ictus postoperatoria fue del 5,2% y la tasa de isquemia medular del 5,9%. Las reintervenciones aórticas fueron necesarias en 12 pacientes (9%).

Conclusiones

La patología de aorta descendente urgente puede ser tratada mediante técnicas endovasculares con resultados óptimos y baja morbimortalidad, aunque ligeramente superior a los casos electivos. Este registro aporta por primera vez, información de la realidad clínica diaria del TEVAR urgente en España.

Palabras clave:
Enfermedades de aorta torácica
Endoprótesis
Reparación endovascular urgente
Disección aórtica
Aneurisma aórtico
Mortalidad
Traumatismo aórtico

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