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Anatomic Severity Grading Score for Primary Descending Thoracic Aneurysms Predicts Reinterventions and Mortality After Thoracic Endovascular Aortic Repair
Chad Ammar, MD, Sebastian Larion, MS, Sadaf S. Ahanchi, MD, Kedar S. Lavingia, MD, David J. Dexter, MD, Jean M. Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
OBJECTIVES:
An anatomic severity grading (ASG) score for primary descending thoracic aortic aneurysms (DTAs) has recently been developed by our group. The objective of this study is to determine if an ASG score cutoff value for DTAs is predictive of reinterventions and mortality in patients undergoing thoracic endovascular aortic repair (TEVAR).
METHODS:
A retrospective review from 2008 to 2013 of patient records was conducted of all consecutive patients who underwent a TEVAR for a primary DTA. A comprehensive scoring system of preoperative DTA morphology based on computed tomography angiography (CTA) images has been established to identify and classify anatomic features that may influence outcome after TEVAR. ASG score calculations were achieved using 3D reconstructions of preoperative CTA images (TeraRecon Aquarius iNtuition Workstation, Foster City, CA). Primary outcomes included aneurysm-related death, 30-day mortality, all-cause mortality, aneurysm rupture, primary technical success, and aneurysm-related reintervention rates. Secondary outcomes included device migration, endoleak formation, endoleak requiring reintervention, hospital readmission within 30 days, stroke, paraplegia, and conversion to open repair.
RESULTS:
Of 469 patients with an ICD-9 diagnosis of a thoracic aortic aneurysm, 62 (13%) patients underwent TEVAR and had adequate preoperative imaging (mean age, 71 years). Applying the ASG score, we identified 30 (48%) patients with a score ≥28 (high score group) and 32 (52%) patients with a score < 28 (low score group). Mean follow-up was 32.8 months post-TEVAR for both groups. Technical success was 100% in both groups. Aneurysm-related and all-cause mortality was significantly higher in the high score versus the low score group (13% vs. 0%, P=0.049 and 27% vs. 3.1%, P=0.011, respectively). A significantly higher reintervention rate (43% vs. 13% P=0.015) was present in the high score versus low score group. Endoleak formation and endoleak requiring reintervention was significantly higher in the high versus the low score group (53% vs 9%, P= <0.001 and 40% vs 6%, P=0.004, respectively). No significant difference in aneurysm rupture (4%), device migration (6%), 30-day hospital readmission (13%), stroke or paraplegia (6%) was present between groups, and no patient had a conversion to open repair during the follow-up period.
CONCLUSIONS:
Preoperative ASG score for primary DTAs predicts reinterventions for endoleaks, aneurysm-related and all-cause mortality after TEVAR.
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