Lauren A Gillinov, Grace J Wang, Nicholas J Goel, Michael A Catalano, Wilson Y Szeto, Venkat R Kalapatapu, Nimesh D Desai
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引用次数: 0
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.
期刊介绍:
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.