Society For Clinical Vascular Surgery

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Descending Thoracic Endovascular Aortic Repair (D-TEVAR) Does Not Require Cardiothoracic Surgery Support
Jesse Chait, Pavel Kibrik, DO, Yuriy Ostrozhynskyy, Albert Pavalonis, DO, Sareh Rajaee, MD, Enrico Ascher, MD.
NYU Langone-Brooklyn, BROOKLYN, NY, USA.

Objective Descending thoracic endovascular aortic repair (D-TEVAR) is often performed by vascular surgeons. At many institutions, cardiothoracic surgery support is required for an elective TEVAR to take place. Oftentimes, this means a dedicated cardiopulmonary bypass team must be available and on site. This study aims to investigate that TEVAR is a safe procedure that does not require such a resource-intensive “back-up plan”.
Methods This is a retrospective analysis of data collected from March 2014 to January 2018 of 18 patients who underwent TEVAR at a tertiary care facility with a level I trauma center. There were 11 males and 7 females with an average age of 68.8 years old (range 19-97; SD +/- 19.52). The average body mass index (BMI) was 24.7 kg/m2 (range 16.8-35; SD +/- 4.67). 9 were never smokers, 4 were former smokers, and 5 were currently smoking at the time of the procedure. The most common presenting symptom prior to intervention was chest pain (n=10), followed by cough/dyspnea (n=5), back pain (n=3), and trauma (n=2).
Results The average maximum diameter of the thoracic aortic aneurysms (TAA) treated with TEVAR was 5.49 cm (n=7; range 4.3-6.7; SD +/- 0.855). Six patients had Stanford Type B aortic dissections. Two patients with TAAs had concomitant, rapidly expanding aortic ulcers.  Two patients had traumatic pseudoaneurysms, one of which ruptured prior to TEVAR. One patient had an expanding 1.9x1.8 cm saccular pseudoaneurysm of the aortic arch.
The mean follow-up time was 69.2 weeks (n=17; range 3-166; SD +/- 62.67), and one patient did not follow up following their initial TEVAR procedure. Of the 18 patients who received TEVAR, there were no major complications. Two patients experienced a type II endoleak. No patients required conversion to an open procedure, nor did any patients necessitate intervention by cardiothoracic surgery or cardiopulmonary bypass support.
Conclusion These data suggest that in select patients, cardiothoracic surgery support is not required for descending thoracic endovascular aneurysm repair (D-TEVAR).


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