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OBJECTIVES:
The most dreaded outcomes after thoracic endovascular aortic repair (TEVAR) is neurological deficits (ND). The objective of this study is to report predictors of ND after TEVAR in dissection versus non-dissection aortic pathology.
Methods:
Multi-center, retrospective review of a prospectively maintained patient registry. The current data set was from the Virginias Regional group of the Society for Vascular Surgery® Patient Safety Organization (SVS PSO). All patients who underwent TEVAR were included. Basic demographic parameters, etiology, comorbidities, and TEVAR procedural details were all considered as potential confounding variables, which were included in logistic regression modeling to predict outcomes. The primary end point of ND is defined as any of the following; TIA, stroke, and paraplegia.
Results:
We analyzed 222 TEVAR procedures from the patient registry performed in 2012-2013. The majority of the patients were male (59.9%) with average (mean + SD) age 65.4 + 15.1 and BMI 27.9 + 5.7. The majority was non-dissection (66.2%) versus dissection aortic repairs (33.8%). Co-morbidities included chronic hypertension (82.9%), CAD (21.6%), CHF (9.0%), diabetes (16.7%), and prior or current tobacco use (79.3%). Forty-five patients (20.3%) had history of aneurysm and 53 (23.9%) had prior aortic surgery. We found no difference in ND rates for dissection (13.3%) versus non-dissection aortic pathology (10.9%) interventions (p=0.660). Following multivariate logistic regression, we found an increase in BMI is associated with decrease likelihood of ND odds ratio ((OR): 0.91, Confidence Interval (CI): 0.93-0.99; p=0.028). In addition, patients receiving TEVAR for emergency or aortic rupture were nearly 3 times as likely to experience ND (OR: 2.92, CI: 1.02-8.35; p=0.046). Neither previous aortic interventions nor length of stent graft were predictors for outcome (p=0.23, p=0.41) respectively. Other predictors such as covering left subclavian, celiac or occluded one or both hypogastric arteries were not also significant (p=0.498, p=0.499, p=0.203), respectively. However, these findings could be Type II error due to the small number of cases with covering and/or revascularization and corresponding ND outcomes.
CONCLUSIONS:
ND is not uncommon after TEVAR emergent repair in Dissection aortic disease. Following TEVAR, the main predictors of ND were increase in BMI and emergent and/or aortic rupture conditions.