Back to 2016 Annual Symposium Abstacts

OBJECTIVES:
Long-term data regarding the safety and durability of thoracic endovascular aortic repair (TEVAR) is limited. The objective of this study was to evaluate the long-term outcomes of thoracic endografts in high-risk patients with descending thoracic aortic pathology.
METHODS:
High-risk patients were treated with thoracic endografts (2001-2011) under a prospective, physician-sponsored investigational device exemption trial. Three-dimensional reconstructions and measurements were performed on computed tomography scans acquired prior to discharge, at 1-, 6-, and 12-months then yearly thereafter. Kaplan-Meier analysis was used to assess survival and freedom from re-intervention.
RESULTS:
Of the 208 patients, 171 were treated for thoracic aneurysm, 28 for chronic dissection, 8 for symptomatic aortic ruptures, and 1 for aortic fistula. Fifty-six patients (26.9%) had prior aortic repair and 84 (40.3%) required surgical modification for adequate landing zone. Patients were followed for an average of 4.8±3.3 years with 97 (46.6%) followed for >5 years. Operative mortality was 6.2%, and survival at 30-days, 1-, 5-, and 9-years was 94.2%, 86.4%, 55.4%, and 31.1%, and freedom from aneurysm-related death was 94.2%, 91.3%, 91.3%, 92.0%, respectively (Figure). Sixty-six endoleaks occurred in 57 patients (28.2% of 202 with eligible imaging), with 31 primary (≤ 30 days) and 35 secondary (> 30 days) endoleaks. Aneurysm growth (>5mm) was noted in 16 patients, with first point of growth noted at a median 3.3 years (IQR 2.0-5.2 years). There were 5 patients who developed component separation, 3 of which were treated with stent-grafts, and 14 patients with barb or stent fractures for which 1 associated re-intervention was performed. Seventy-five re-interventions were performed in 55 patients, with overall freedom from re-intervention at 30-days, 1-, 5-, and 8-years of 88.8%, 81.9%, 74.1%, and 62.7%, respectively. Fifty-three (71%) of re-interventions were thoracic aneurysm-related, 40 (75%) of which were endovascular procedures. Thirty-five of these were to correct endoleaks with median time of 1.5 years (IQR 0.1-6.1 years).
CONCLUSIONS:
When implanted according to strict anatomic criteria, TEVAR devices are durable and associated with high long-term aneurysm-related survival. Long-term imaging follow-up remains critical to identify endoleaks or rare device durability issues, most of which can be monitored or managed with endovascular therapies.