Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience
Background. Implementation of emergency endovascular aortic repair provides an attractive opportunity in the treatment of complicated acute aortic syndromes involving descending aorta. Aim. The aim of this study was to analyze the effectiveness of thoracic endovascular aortic repair (TEVAR) for the...
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Wiley
2023-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2023/6600035 |
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| author | Piotr Buczkowski Mateusz Puslecki Marcin Ligowski Marek Dabrowski Sebastian Stefaniak Zuzanna Fryska Jerzy Kulesza Robert Juszkat Marek Jemielity Bartlomiej Perek |
| author_facet | Piotr Buczkowski Mateusz Puslecki Marcin Ligowski Marek Dabrowski Sebastian Stefaniak Zuzanna Fryska Jerzy Kulesza Robert Juszkat Marek Jemielity Bartlomiej Perek |
| author_sort | Piotr Buczkowski |
| collection | DOAJ |
| description | Background. Implementation of emergency endovascular aortic repair provides an attractive opportunity in the treatment of complicated acute aortic syndromes involving descending aorta. Aim. The aim of this study was to analyze the effectiveness of thoracic endovascular aortic repair (TEVAR) for the treatment of acute surgical emergencies involving the descending thoracic aorta. Methods. A retrospective review of the medical records of all patients undergoing TEVAR in a single center since 2007 was undertaken. Patients with the aortic disease treated on emergency inclusion criteria were complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other indications requiring emergent intervention. Technical and clinical success with patient mortality, survival, and reoperation rate was evaluated according to Society for Vascular Surgery reporting standards for thoracic endovascular aortic repair (TEVAR). Results The emergency interventions were necessary in 74 cases (51.0%), including patients with the complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48) and traumatic aortic acute injuries (TAIs) (31.1%). In addition, in one case aortic iatrogenic dissection (AID) and in 2 other fistulas after the previous stent graft, implantations were diagnosed. All procedures were done through surgically exposed femoral arteries while 2 hybrid procedures required additional approaches. The primary technical success rate was 95.9%, in 3 cases endoleak was reported. The primary clinical success occurred in 94.5%. All patients survived the endovascular interventions, whereas during in-hospital stay one of them died due to multiorgan failure (early mortality 1.3%). During the follow-up period, lasting 6 through 164 months (median 67), 11 patients died. Annual, five- and ten-year probability of survival was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, the rate of 5-year survivors was significantly higher after TAI (95.2%) than scAAS (63.4%) (p=0.008). Early after the procedure, one individual developed transient paraparesis (1.3%). No other serious stent-graft-related adverse events were noted within the postdischarge follow-up period. Conclusions. Descending aortic pathologies requiring emergent interventions can be treated by endovascular techniques with optimal results and low morbidity and mortality in an experienced and dedicated team. |
| format | Article |
| id | doaj-art-b0675e0dca574865b0738973030c700e |
| institution | Kabale University |
| issn | 2090-2859 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-b0675e0dca574865b0738973030c700e2025-02-03T05:57:24ZengWileyEmergency Medicine International2090-28592023-01-01202310.1155/2023/6600035Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center ExperiencePiotr Buczkowski0Mateusz Puslecki1Marcin Ligowski2Marek Dabrowski3Sebastian Stefaniak4Zuzanna Fryska5Jerzy Kulesza6Robert Juszkat7Marek Jemielity8Bartlomiej Perek9Department of Cardiac Surgery and TransplantologyDepartment of Cardiac Surgery and TransplantologyDepartment of Cardiac Surgery and TransplantologyPolish Society of Medical SimulationDepartment of Cardiac Surgery and TransplantologyFaculty of MedicineDepartment of RadiologyDepartment of RadiologyDepartment of Cardiac Surgery and TransplantologyDepartment of Cardiac Surgery and TransplantologyBackground. Implementation of emergency endovascular aortic repair provides an attractive opportunity in the treatment of complicated acute aortic syndromes involving descending aorta. Aim. The aim of this study was to analyze the effectiveness of thoracic endovascular aortic repair (TEVAR) for the treatment of acute surgical emergencies involving the descending thoracic aorta. Methods. A retrospective review of the medical records of all patients undergoing TEVAR in a single center since 2007 was undertaken. Patients with the aortic disease treated on emergency inclusion criteria were complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other indications requiring emergent intervention. Technical and clinical success with patient mortality, survival, and reoperation rate was evaluated according to Society for Vascular Surgery reporting standards for thoracic endovascular aortic repair (TEVAR). Results The emergency interventions were necessary in 74 cases (51.0%), including patients with the complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48) and traumatic aortic acute injuries (TAIs) (31.1%). In addition, in one case aortic iatrogenic dissection (AID) and in 2 other fistulas after the previous stent graft, implantations were diagnosed. All procedures were done through surgically exposed femoral arteries while 2 hybrid procedures required additional approaches. The primary technical success rate was 95.9%, in 3 cases endoleak was reported. The primary clinical success occurred in 94.5%. All patients survived the endovascular interventions, whereas during in-hospital stay one of them died due to multiorgan failure (early mortality 1.3%). During the follow-up period, lasting 6 through 164 months (median 67), 11 patients died. Annual, five- and ten-year probability of survival was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, the rate of 5-year survivors was significantly higher after TAI (95.2%) than scAAS (63.4%) (p=0.008). Early after the procedure, one individual developed transient paraparesis (1.3%). No other serious stent-graft-related adverse events were noted within the postdischarge follow-up period. Conclusions. Descending aortic pathologies requiring emergent interventions can be treated by endovascular techniques with optimal results and low morbidity and mortality in an experienced and dedicated team.http://dx.doi.org/10.1155/2023/6600035 |
| spellingShingle | Piotr Buczkowski Mateusz Puslecki Marcin Ligowski Marek Dabrowski Sebastian Stefaniak Zuzanna Fryska Jerzy Kulesza Robert Juszkat Marek Jemielity Bartlomiej Perek Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience Emergency Medicine International |
| title | Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience |
| title_full | Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience |
| title_fullStr | Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience |
| title_full_unstemmed | Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience |
| title_short | Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience |
| title_sort | emergency endovascular interventions on descending thoracic aorta a single center experience |
| url | http://dx.doi.org/10.1155/2023/6600035 |
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