Open versus Endovascular Repair of Arch and Descending Thoracic Aneurysms: A Retrospective Comparison

Ann Vasc Surg. 2016 Feb:31:30-8. doi: 10.1016/j.avsg.2015.08.014. Epub 2015 Nov 23.

Abstract

Background: Thoracic aortic aneurysms (TAAs) contribute significant mortality if left untreated, but surgical repair has historically carried substantial risks.

Methods: We sought to observe trends and outcomes of open and endovascular thoracic endovascular aneurysm repair thoracic aortic repairs, so conducted a retrospective review of all patients who presented for management of TAAs from 2003 to 2013 at 2 hospitals in Sydney, Australia.

Results: A total of 179 patients presented with TAAs over the study period, including 5 ruptures. Fifty-two were treated nonoperatively, with 127 surgically repaired. Operative duration was significantly shorter in endovascular than open repair of arch (193 ± 108 vs. 396 ± 98 min, P = 0.0001) and descending aneurysms (242 ± 116 vs. 422.5 ± 161 min, P = 0.003). There were no differences in mortality or complication rates (including paraplegia), duration of hospital or intensive care unit stay, or transfusion requirements between endovascular and open TAA repairs.

Conclusions: Apart from reduced surgical duration, this study revealed no benefits of endovascular over open TAA repair. Overall morbidity and mortality were low, even in elderly patients.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Rupture / diagnosis
  • Aortic Rupture / mortality
  • Aortic Rupture / surgery*
  • Blood Loss, Surgical / prevention & control
  • Blood Transfusion
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / mortality
  • Blood Vessel Prosthesis Implantation* / trends
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Endovascular Procedures* / trends
  • Female
  • Humans
  • Male
  • Middle Aged
  • New South Wales
  • Operative Time
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome