Despite improvements in perioperative diagnosis, treatment and postoperative care, surgical repair of ruptured thoracic aortic aneurysms (r-TAA) has continued to have a high morbidity and mortality.
However, a new study of endovascular repair of r-TAA was associated with markedly reduced mortality and improved mid-term survival, when compared to open surgical approach in a prospective intent-to-treat longitudinal study by the Albany Vascular Group in Albany, N.Y. The results were presented at the Vascular Annual Meeting June 5-8 in San Diego, Calif. by Manish Mehta, MD, associate professor of surgery and co-author of the study. Since 2001, a total of 121 patients presented emergently with r-TAA at The Vascular Institute for Health and Disease, Albany Medical Center. Forty-three percent of the patients underwent emergent thoracic endovascular aneurysm repair (TEVAR) and 57 percent had emergent open surgical repair. Compared to the open surgical group, the endovascular patients had significantly higher pre- existing defined comorbidities, including coronary artery disease (47 percent vs. 17 percent), hypertension (69 percent vs. 30 percent), chronic obstructive pulmonary disease (21 percent vs. 4 percent) and chronic renal insufficiency (16 percent vs. 4 percent). Neurological complications, including paraplegia and stroke, also occurred more frequently in the open group (16 percent vs. 5 percent). Over a mean follow-up of 15 months, 11 percent of the patients in the endovascular group and 16 percent of the patients in the open surgical group required secondary adjunctive procedures. According to Dr. Mehta, MD, use of endovascular techniques for emergent treatment of r- TAA increased annually from 29 percent in 2005 to 67 percent in 2006, up to 90 percent in 2007. Prior to 2005, open surgical repair of r-TAA was the primary treatment of choice. Surgeons at the Vascular Institute for Health and Disease said the ability to treat r-TAA by endovascular means has had a significant effect on improving patient survival. "The life table analysis indicated the cumulative survival in the endovascular group to be significantly better than the open surgical group at 30-day, 71 percent vs. 44 percent; 1-year, 51 percent vs. 33 percent; 2 -year, 45 percent vs.33 percent; and 3-year, 45 percent vs. 26 percent," Dr. Mehta said. "Besides improving on the morbidity and mortality of these complex high risk procedures, with an endovascular approach we can expand on offering this treatment to patients with significant co- morbidities who might otherwise been left untreated." VTN |
