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TEVAR Results When Used Selectively With IFU Compliant Landing Zones
Alan P. Sawchuk, MD, Luona Sun, MD, Raghu Motaganahalli, MD, Andres Fajardo, MD, Gary Lemmon, MD, Michael Dalsing, MD.
Indiana University, Indianapolis, IN, USA.
TEVAR Results When Used Selectively With IFU Compliant Landing Zones
Objectives: Our purpose was to evaluate the intermediate TEVAR results in an institution with a complex variety of aortic pathologies in a setting with skilled open surgeons where most TEVAR procedures were done with optimal landing zones.
Methods: Fifty-eight TEVAR procedures in our most recent two years extending from October, 2009 to October, 2011 were reviewed. Over this two year time interval 141 open thoracic aortic repairs were done. 30 day TEVAR morbidity and mortality, intermediate term morbidity and mortality and the need for re-intervention were retrospectively reviewed.
Results: The 58 patients consisted of 42 males and 16 females. 17 patients required urgent TEVAR for traumatic injury, while 41 patients were repaired for degenerative disease. Six were done emergently for acute TAA rupture or complex type B thoracic aortic dissection. Thirty-three patients underwent debranching of the proximal landing zone by a carotid-subclavian bypass (CSB) or transposition. One patient required re-intervention for a type I endoleak on day 7 with a successful result. There were no other re-interventions required for a type I or II endoleak. Two patients died within 30 days due to traumatic injuries not related to their TEVAR repair for a 30 day perioperative mortality of 3.4 percent. No deaths were directly related to TEVAR repair. Four patients had perioperative complications related to TEVAR repair: stroke (2), lower extremity paralysis (1), and R EIA rupture (1), for a perioperative morbidity of 6.9 percent. There were no deaths during the two year follow up related to the aortic repair or TEVAR procedure.
Conclusions: In an institution with a high volume of TEVAR repairs by experienced interventionalists and skilled open surgeons who proceed to open repair when the thoracic aortic anatomy is inadequate for a good TEVAR result, TEVAR TAA repair can be done with an exceptionally low mortality (3.4 percent) and morbidity (6.9 percent).
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