Long-term outcomes of thoracic endovascular aortic repair for descending thoracic aortic aneurysms based on pooled results from FDA clinical trials.

Abstract

Objective: Thoracic endovascular aortic repair is the preferred treatment for descending thoracic aortic aneurysms, but long-term data are limited. This study assessed long-term results of thoracic endovascular aortic repair in early recipients of thoracic endovascular aortic repair devices who were enrolled in FDA investigational device exemption clinical trials for aneurysm.

Methods: This was a single-center retrospective study including 179 patients enrolled in 14 clinical trials for thoracic endovascular aortic repair for descending thoracic aortic aneurysm between 2000 and 2019. The primary outcome was ten-year mortality. Secondary outcomes included a 30-day composite of death or neurologic event, endoleak, reintervention, and aortic diameter on follow-up imaging. Descriptive statistics, Kaplan-Meier survival analysis, Cox proportional hazards models, and cumulative incidence functions with competing risk were used for analysis.

Results: Median age was 74 years and median follow up was 5.5 years. Aneurysm morphology was fusiform (N=100, 55.9%) or saccular (N=70, 39.1%), with median preoperative diameter of 60.0 millimeters. Survival at one, five, and ten years was 91.1%, 62.8%, and 31.4%. Endoleak was observed in 58 patients (32.4%), and reintervention in 44 patients (24.6%). Neither endoleak nor reintervention was associated with all-cause mortality at ten years. Increasing age and preoperative aneurysm diameter were independent predictors of mortality. A majority of patients (73.8%) had stable aneurysm sac at five years.

Conclusions: While overall survival at ten years was limited, early outcomes were favorable and most patients had stable aneurysm sac at five years. Endoleak and reintervention were not linked to long-term mortality, whereas age and preoperative aortic diameter predicted worse survival. In this older patient cohort, durability of thoracic endovascular aortic repair remains a concern.