Endovascular Treatment for Nontraumatic Rupture of the Descending Thoracic Aorta: Long-Term Results

Background This study evaluated the long-term results of thoracic endovascular aortic repair (TEVAR) of nontraumatic rupture of the descending thoracic aorta. Methods This was a retrospective and observational single-center study. During the 10-year study period, 21 patients (6 males) with an average age of 66.1 +/- 12.4 (range 31-81) years underwent emergency TEVAR for nontraumatic rupture of the descending thoracic aorta. The underlying aortic pathologies causing the rupture were degenerative aneurysms in 11 patients, complicated type B dissection in nine, and erosion hemorrhage due to neoplasia in one patient. Results The 30-day mortality rate was 9.5% (2/21). Two patients died postoperatively: one from a repeat aortic rupture and the other from pneumonia. Two patients underwent early endovascular reintervention. After a median follow-up of 65.6 +/- 50.4 (range 1.5-44) months, 10 patients died, resulting in a late mortality of 52.6% (10/19). Six patients (31.5%) developed major complications requiring late reintervention. There was no mortality with reintervention. Conclusions Endovascular treatment of the descending thoracic aorta in patients with nontraumatic rupture is a promising treatment option in an emergency setting with a relatively low mortality rate. Despite encouraging early results, TEVAR is associated with a high reintervention rate and poor survival due to nonaortic or procedure-related mortality in the long term. doi: 10.1111/jocs.12329 (J Card Surg 2014;29:353-358)