Abstract：
BACKGROUND: Several studies have reported short- and intermediate-term outcomes after thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (DTAA); however, reports on long-term (10 years) outcomes are sparse. Therefore, the aim of this study was to analyze predictors impacting long-term outcome after TEVAR for DTAA.
METHODS: Databases from four academic institutions were reviewed and consecutive cases of TEVAR for DTAA between 1999 and 2021 were included in this retrospective multicenter study (case series). Ethical approval from the institutional review board was obtained and patient demographics and treatment data, as well as follow-up information were retrieved and analyzed.
RESULTS: We identified 305 patients (mean age, 72 ± 10 years) who were treated with TEVAR for degenerative DTAA with a mean aortic diameter of 64 mm. Altogether 445 endografts were implanted via femoral access (93%) with a technical success of 94%. Operative mortality, stroke rate, and rate of spinal cord ischemia were 6% (5% for intact, 12% for ruptured DTAA), 4%, and 3%, respectively. Kaplan-Meier estimates for overall survival rates were 76%, 59% and 34% at 1, 5 and 10 years and freedom from reintervention rates were 84%, 73% and 58% at 1, 5 and 10 years, respectively. In multivariate analysis, American Society of Anesthesiologists grade 3 to 5 and nonelective case were identified as predictors for death, whereas as fusiform DTAA, proximal landing zone 2, and hypertension, but not device generation, were predictive for reintervention.
CONCLUSIONS: This study is, to date, the largest reporting long-term (10 years) outcome on TEVAR for DTAA. We found acceptable rates for long-term survival and freedom from reintervention that were independent of endovascular device generation.
METHODS: Databases from four academic institutions were reviewed and consecutive cases of TEVAR for DTAA between 1999 and 2021 were included in this retrospective multicenter study (case series). Ethical approval from the institutional review board was obtained and patient demographics and treatment data, as well as follow-up information were retrieved and analyzed.
RESULTS: We identified 305 patients (mean age, 72 ± 10 years) who were treated with TEVAR for degenerative DTAA with a mean aortic diameter of 64 mm. Altogether 445 endografts were implanted via femoral access (93%) with a technical success of 94%. Operative mortality, stroke rate, and rate of spinal cord ischemia were 6% (5% for intact, 12% for ruptured DTAA), 4%, and 3%, respectively. Kaplan-Meier estimates for overall survival rates were 76%, 59% and 34% at 1, 5 and 10 years and freedom from reintervention rates were 84%, 73% and 58% at 1, 5 and 10 years, respectively. In multivariate analysis, American Society of Anesthesiologists grade 3 to 5 and nonelective case were identified as predictors for death, whereas as fusiform DTAA, proximal landing zone 2, and hypertension, but not device generation, were predictive for reintervention.
CONCLUSIONS: This study is, to date, the largest reporting long-term (10 years) outcome on TEVAR for DTAA. We found acceptable rates for long-term survival and freedom from reintervention that were independent of endovascular device generation.
摘要：
背景：一些研究报道了TEVAR治疗胸主动脉瘤降动脉瘤（DTAA）后的短期和中期结果，然而,关于长期(10年)结果的报告很少。因此,本研究的目的是分析影响胸主动脉腔内修复术(TEVAR)治疗DTAA后长期结局的预测因素.
方法：回顾了来自四个学术机构的数据库，并将1999年至2021年间TEVAR用于DTAA的连续病例纳入了这项回顾性多中心研究（病例系列）。获得了机构审查委员会的道德批准，患者人口统计，检索并分析治疗数据和随访信息.
结果：305例患者（平均年龄72±10岁）接受TEVAR治疗的退行性DTAA，平均主动脉直径为64mm。通过股骨入路总共植入了445个移植物（93％），技术成功率为94％。手术死亡率，中风率和脊髓缺血率为6%(5%为完整，DTAA破裂的12%)，4%和3%,分别。Kaplan-Meier估计总生存率为76%，1年、5年和10年的59%和34%，再干预的自由率为84%，1年、5年和10年分别为73%和58%，分别。在多变量分析中，ASA3-5级和非选择性病例被确定为死亡的预测因子，作为梭形DTAA，近端着陆区2和高血压而非装置生成是再干预的预测因素.
结论：这是迄今为止最大的一项报告DTAATEVAR长期（10年）结果的研究。我们发现长期生存率和无再干预的可接受率与血管内装置的生成无关。
方法：回顾了来自四个学术机构的数据库，并将1999年至2021年间TEVAR用于DTAA的连续病例纳入了这项回顾性多中心研究（病例系列）。获得了机构审查委员会的道德批准，患者人口统计，检索并分析治疗数据和随访信息.
结果：305例患者（平均年龄72±10岁）接受TEVAR治疗的退行性DTAA，平均主动脉直径为64mm。通过股骨入路总共植入了445个移植物（93％），技术成功率为94％。手术死亡率，中风率和脊髓缺血率为6%(5%为完整，DTAA破裂的12%)，4%和3%,分别。Kaplan-Meier估计总生存率为76%，1年、5年和10年的59%和34%，再干预的自由率为84%，1年、5年和10年分别为73%和58%，分别。在多变量分析中，ASA3-5级和非选择性病例被确定为死亡的预测因子，作为梭形DTAA，近端着陆区2和高血压而非装置生成是再干预的预测因素.
结论：这是迄今为止最大的一项报告DTAATEVAR长期（10年）结果的研究。我们发现长期生存率和无再干预的可接受率与血管内装置的生成无关。
