Estudio multicéntrico de la reparación endovascular urgente de la aorta torácica: indicaciones y resultados

Abstract

Objective: Endovascular techniques have become an essential tool for the treatment of des- cending 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 tho- racic 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; 2) Blunt trau- matic thoracic aortic injury; 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 ruptured descending thoracic aortic aneurysms 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.