Tratamento endovascular de patologia da aorta torácica: experiência institucional

Abstract

Introduction

Endovascular treatment of the thoracic aorta is a technique which has revolutionized the treatment of different aortic pathologies.

Objectives

Our purpose is to evaluate our institutional experience

Methods

We present a retrospective analysis of a consecutive series of patients who underwent TEVAR at our Instituition. Patients who received fenestrated/branched abdominal devices were excluded.

Results

From April 2005 to Abril 2014, 79 patients with a mean age of 66 ± 12.83 years (range 14 to 86) underwent TEVAR. The indications included: 46 thoracic aortic aneurysms (TAA) (58%), 17 aortic dissections (AD) Stanford B (22%), 13 due to other acute aortic syndromes (AAS) (16%), 2 due to atheroembolism (3%) e 1 due to an aortic‐esophageal fistula (1%).

The aortic aneurysms were located to the ascending aortic and arch in 5 cases (11%), the descending thoracic aorta in 35 (76%) and the thoracoabdominal aorta in 6 (13%).

Mean aneurysm diameter was 69.64 mm (max 150 mm). Rupture was the clinical presentation in 21.5% of the patients (n = 17). 20.9% of the patients had previous aortic surgery.

TEVAR was performed for acute complicated Stanford type B AD in 13 patients (76%) and for chronic AD in 4 (24%). AD‐related complications included aneurysmatic dilatation in 35% (n = 6), organ malperfusion in 47% (n = 8). The Petticoat technique was performed in 9 cases (41.2%) and adjuvant procedures were necessary in 18% (renal artery stenting in 2; iliac artery stenting in 1).

Regarding the other AAS, TEVAR was performed due to penetrating aortic ulcer in 4 cases, intra‐mural hematome in 4 and in 5 cases due to rupture/pseudoaneurysm.

The deployed endografts included 32 Valiant Medtronic^®, 15 TAG Gore^®, 25 Zenith TX2 Cook^®, 2 Zenith TX1 Cook^®, 1 Relay Plus^®, 3 Talent Medtronic^®. The median length of stay in the intensive care unit was 2 days (range 0‐42) and median 2 units of erythrocytes was transfused per patient.

Thirty‐day/intrahospitalar mortality was 18% (n = 14). Mortality in elective procedures was 8% (4 in a total of 50) and 35% in urgent cases (10/29). Intraoperative additional interventions were required in 7 patients due to access vessel complications, in 2 due to iatrogenic AD, in 1 case due to acute limb thromboembolic ischemia and in 1 case to to a type IA endoleak. Reintervention rate was 17%, with the following indications: 9 endoleaks, 2 mesenteric ischemias and 2 aortic‐esophageal fistulae.

Conclusions

Our series represents an encouraging institutional experience, with reproducible outcomes. TEVAR is a safe and effective intervention for the management of different thoracic aortic pathologies, when compared to open surgery.