Single-Center Outcomes of TEVAR Studied in a Variety of Pathologies

June 28, 2011—In Circulation, W. Anthony Lee, MD, et al reported the late outcomes of a large, decade-long, single-center, thoracic endovascular aortic repair (TEVAR) experience (2011;123:2938–2945).

The investigators concluded that there appeared to be a substantial number of late deaths, which may represent a combination of poor patient selection and treatment failures. They also found that TEVAR may be used to treat a variety of thoracic aortic pathologies with a very low risk of intraoperative conversion. Overall rates of mortality and neurological complications were relatively low, but were significantly increased in emergent repairs. 

As detailed in Circulation, the investigators reviewed a prospectively maintained registry and the electronic medical records of 400 consecutive TEVAR procedures performed at this tertiary care center. The distribution of pathologies treated included aneurysms (198, 49%), dissections (100, 25%), penetrating ulcers (54, 14%), traumatic transections (25, 6%), and other pathologies (23, 6%). Spinal drains were placed prophylactically in 127 cases (32%) of planned extended aortic coverage. There were no acute surgical conversions. Adjunctive surgical procedures were performed on 94 patients (24%). Subclavian revascularizations were performed selectively in only 15% of zone 0 to 2 deployments. The median length of stay was 5 days (limits, 1 and 79 days).

The investigators reported that the overall 30-day mortality rate was 6.5% (elective, 2.6%; urgent, 9.5%; and emergent, 20%). Permanent spinal cord ischemia occurred in 4.5% and stroke in 3%. At 6, 12, 24, and 36 months, Kaplan-Meier estimates of survival were 82%, 76%, 68%, and 60%, and freedom from secondary intervention rates were 90%, 86%, 81%, and 78%, respectively. Risk factors for mortality included stroke, urgent/emergent repair, age ≥ 80 years, general anesthesia, and dissection pathology, stated the investigators in Circulation.

Editor's Note: This is a corrected version of the story originally posted for the July 7, 2011, edition of the Endovascular Today eNews, which incorrectly identified the hospital where the single-center study was conducted. W. Anthony Lee, MD, et al conducted the study at Shands at University of Florida in Gainesville, Florida. The original Endovascular Today article misidentified the center as the Christine E. Lynn Heart and Vascular Institute in Boca Raton, Florida, where Dr. Lee now serves as Director of Endovascular Program.