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Objective:
Thoracic aortic pathologies, such as dissections, penetrating ulcers, aneurysms, and traumatic injuries, are potentially life threatening medical conditions that require close observation and many times interventions. The purpose of this study is to determine if having elective or urgent indications for thoracic endovascular aneurysm repair (TEVAR) affects procedural outcomes.
Methods:
A retrospective review of a maintained database was performed on all patients undergoing TEVAR at a tertiary hospital from 2001 to 2013. Patients were categorized as having either an elective or urgent TEVAR. Demographics, intraoperative parameters, follow-up data, complications, endoleak rates and types, reinterventions, and mortality rates were compared between the two groups.
Results:
A total of 106 patients were categorized as having either an elective (73 patients) or urgent (33 patients) TEVAR. The mean age was 73.4±10.7 years in the elective group and 69.7±14.9 years in the urgent group (P=NS). The majority of the patients were male, 67.1% in elective cases and 51.5% in the urgent cohort (P=NS). Ethnicities did not vary between groups, with the majority being Caucasian (58.9% in elective, 42.2% in urgent, P=NS). Mean follow-up time was 2.68±3.0 years for the elective group and 2.10 ±2.7 for the urgent group (P=NS). Complication rates (intraoperative, perioperative, and late onset) had a three-fold increase in the urgent group when compared to elective cases (36.4% vs.11.0%, P=0.001). Length-of-stay (LOS) doubled in the urgent group when compared to the elective group (16.3±13.4 days vs.8.3 ± 20.9 days, P=0.069). There was no difference in 30-day aneurysm-related and 30-day all-cause mortality between the elective and the urgent groups (P=NS). Overall, the all-cause late mortality in this cohort is high, 41.1% in the elective group and 36.4% in the urgent group (P=NS). Patients ≥70 years-of-age had a two-fold increase in all-cause mortality when compared to patients under the age of 70 (53.7% vs.20.5%, P=0.001).
CONCLUSIONS:
Having an urgent indication for TEVAR triples the complication rate and doubles the LOS when compared to elective cases. All-cause mortality rates are two-fold higher in patients ≥70 years-of-age. These findings should be considered when planning TEVAR.

Mean follow-up time, complications, length of stay and mortality

Parameter	Elective Group No. (%) (N=73)	Urgent Group No. (%) (N=33)	P value
Mean follow-up time ± SD, years	2.68±3.0	2.10 ±2.7	NS
Any complication	8 (11.0)	12 (36.4)	0.001
Intraoperative complications	1 (1.4)	2 (6.1)	NS
Perioperative complications	5 (6.8)	6 (18.2)	0.067
Late onset complications	4 (5.5)	5 (15.2)	0.087
Length-of-stay ± SD, days	8.3 ± 20.9 days	16.3±13.4	0.069
30-day TAA-related mortality	1 (1.4)	1 (3.0)	NS
All-cause late mortality	30 (41.1)	12 (36.4)	NS