Longitudinal Outcomes of Thoracic Endovascular Aortic Repair for Ruptured Thoracic Aortic Aneurysms.

ABSTRACT

OBJECTIVES: Limited data exist on long-term mortality and reintervention rates of emergent thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysm (rTAA). This study aimed to characterize the long-term outcomes of emergent TEVAR for rTAA. METHODS: This study reviewed all TEVARs for emergent rTAA and elective intact thoracic aortic aneurysms (iTAA) from August 2005 to March 2022 at a large academic medical center. Outcomes, including overall survival and reinterventions, were considered over eight years. RESULTS: Of 321 patients, 65 received TEVAR for rTAA (34 hemodynamically stable) and 256 for iTAA. Respective mean (SD) ages were 74.4 (11.9) and 74.7 (9.1) years. Median follow-up was 5.1 years. rTAA patients had lower 30-day survival (69.2% vs 96.9%, P < .001) and higher rates of stroke, pneumonia, and prolonged ventilation (all P ≤ .01). Survival was significantly worse for rTAA at 1 year (46% vs 86%), 5 years (27% vs 48%), and 8 years (20% vs 32%; all P < .001). For patients surviving at least 90 days, the long-term survival difference narrowed to statistical insignificance. Ruptured aneurysms required more reinterventions within 30 days, but comparable long-term reintervention rates. Indications for reintervention were similar, with type I endoleak as the leading cause. Long-term survival for hemodynamically stable rTAA patients did not differ significantly from iTAA patients (49% vs 48% at 5 years). CONCLUSIONS: Short-to-medium-term outcomes are worse for ruptured aneurysms. However, long-term survival of hemodynamically stable rTAA patients and rTAA patients who survive the first 90 days are comparable to iTAA patients.