This article is more than 5 years old. Information may no longer be current.
Penetrating aortic ulcer increases risk for severe complications from TEVAR
Click Here to Manage Email Alerts
In patients with penetrating aortic ulcer, severe underlying atherosclerotic disease and CV comorbidities frequently lead to mortality and morbidity after thoracic endovascular aortic repair, according to recent findings.
Researchers reviewed the medical records database at the West-German Heart and Vascular Center in Essen, Germany, to identify 63 consecutive patients who were treated with thoracic endovascular aortic repair (TEVAR) for complicated penetrating aortic ulcer (PAU) between 2002 and 2013. The mean age of the patients was 69.1 ± 11.5 years (40 men). Forty-two patients were symptomatic, and 22 had aortic rupture. In roughly 50% of patients, the site of the PAUs were the aortic arch (n = 11) and the descending thoracic aorta (n = 43). Additionally, nine PAUs were also located in the thoracoabdominal aorta, and seven patients had more than one PAU. The patients were followed until December 2014.
The researchers found that in 33 cases (52.3%), TEVAR was performed within 14 days of diagnosis, with 19 ruptures treated immediately. Among the remaining 30 patients (47.6%), the average timeline between diagnosis and treatment was 40 ± 39 days. PCI for severe CAD was performed in advance of TEVAR in eight patients (12.7%), and in two patients, carotid-to-subclavian artery bypass was performed before TEVAR. Most patients (83.5%) received one stent graft, and 11 patients received two stent grafts.
The primary technical success of the procedure was 98.4%. A type 1 endoleak occurred in one patient after stent graft repair of a PAU in the aortic arch without transposition. A subsequent procedure was needed to create a left carotid-to-subclavian artery bypass to proximally extension of the first stent graft. Spinal cord ischemia did not occur in any of the patients after TEVAR, and all patients were asymptomatic post-TEVAR. In-hospital mortality occurred in five patients (7.9%); of these, three had severe cardiac complications, one died due to aortic rupture complications and one died of septic shock with multiple organ failure.
During a mean follow-up of 45.6 ± 47.2 months, 12 patients (19%) required a secondary intervention owing to late endoleaks (n = 4; 6.3%) or the onset of index complications resulting from disease progression. In multivariate analysis, researchers found an independent predictive association between PAU depth of more than 15 mm and mortality (HR = 6.92; P = .03). According to biomarker analysis, compared with asymptomatic patients, those with symptoms had significantly higher D-dimer and cardiac troponin concentrations (D-dimer: 559.5 ± 460.7 for symptomatic patients vs. 283.2 ± 85.2 μg/L; P = .016; and troponin: 0.22 ± 0.61 vs. 0.02 ± 0.03 ng/mL; P = .04).
According to the researchers, TEVAR-related complications in patients with PAU can be avoided through diligent risk factor assessment and long-term monitoring.
"After TEVAR, long-term surveillance is crucial to discover complications due to TEVAR and monitor the progress of the [CVD]," the researchers wrote. "As the overall prognosis is highly dependent on the accompanying comorbidities, rigorous risk factor management is necessary, especially one that includes preoperative cardiac evaluation." – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts