Timing Of Re-intervention Following Thoracic Endograft Repair
Nicholas Russo, MD, Tigran Divanyan, MD, Neil Patel, MD, Jeffrey Hnath, MD, R Clement Darling III, MD.
Albany Medical Center / Albany Medical College, Albany, NY, USA.
OBJECTIVES: Reinterventions after thoracic endograft for dissection (TEVAR-D) and aneurysm (TEVAR-A) have been studied recently but did not clearly delineate the timing and types of subsequent re-interventions. This study aims to identify when most of these re-interventions occur in order to improve patient preoperative education, refine imaging, and follow up protocols that target the most likely time points in which a reintervention would become necessary. METHODS: A single tertiary care academic vascular group was queried for any patient who received placement of a thoracic endograft device for either dissection or aneurysm between June 2013 and December 2019. Demographics, indications, operative details and long-term results were retrospectively reviewed and compared. Standard statistical analysis was performed. RESULTS: 288 patients received thoracic endografting for TEVAR-D (127/44%) or TEVAR-A (161/56%) between June 2013 and December 2019. Demographics were similar in terms of comorbid conditions including hypertension, diabetes, coronary artery disease etc. TEVAR-D group was significantly younger (p value: .0001, mean: 62 years old, range: 22-91), TEVAR-A (mean: 75, range: 28-95). Perioperative blood loss, operative mortality, readmission 30 days, paralysis and stroke were similar between groups. TEVAR-D trended towards increased rate of reintervention at the 30-day mark following index procedure. TEVAR-A was more likely to require reintervention at the 1-year interval (p=.0234). Reinventions were similar between the groups including coils, extensions, stent placement except for revisions requiring open aortic repair. TEVAR-D group was more likely to require an open aortic revision of some kind throughout the natural history of their device (p= .0403). Overall survival at 2 years between the groups was similar between TEVAR-D and TEVAR-A (75% vs 72% p value: 1). CONCLUSIONS: Thoracic endograft repair for aortic pathology has demonstrated a need for re-intervention in order to maintain repair integrity. This study was able to elucidate the specific nature of the re-interventions as well as clarify the timing for re-intervention with respect to dissection and aneurysm. This study helps to improve pre-operative patient education as well as improve goal targeted surveillance of thoracic endograft repair.
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