Thoracic Endovascular Aortic Repair for the Treatment of Acute Aortic Rupture

Objectives: The aim of this study was to analyze outcomes of thoracic endovascular aortic repair (TEVAR) for the treatment of acute aortic rupture.

Methods: Between 01/2009 and 12/2019, a total of 82 patients underwent emergent TEVAR for acute thoracic aortic rupture. Patient and outcome characteristics were retrospectively analyzed.

Result: Acute thoracic aortic rupture occurred in patients with chronic aortic aneurysms (n = 42, 51%), acute aortic dissection (n = 10, 12%), chronic aortic dissection (n = 3, 4%), or after trauma (n = 27, 33%). Mean age of the 50 male (61%) and 32 female (39%) patients was 67 [first quartile: 57, third quartile: 75] years, including 1 patient (1%) with Marfan syndrome. A preoperative spinal cord drainage was placed in 9 patients (11%) and perioperative supra-aortic transposition was performed in 18 patients (22%). The proximal landing zones were zone 1 (n = 1, 1%), zone 2 (n = 22, 27%), zone 3 (n = 50, 61%), and zone 4 (n = 9, 11%). Median X-ray time was 10 [6, 15] minutes and median procedure time was 104 [75, 154] minutes. Temporary spinal cord injury occurred in one patient (1%), and permanent spinal cord injury in seven patients (9%). Two patients (2%) developed a postoperative stroke. Sixteen patients (20%) died in the hospital. After TEVAR, 18 patients (22%) required a stent-graft–related aortic reintervention for symptomatic supra-aortic malperfusion (n = 3, 4%), endoleaks (n = 6, 7%), a second aortic rupture (n = 4, 5%), retrograde type A aortic dissection (n = 2, 2%), aortic esophageal fistulation (n = 2, 2%), and stent-graft kinking (n = 1, 1%).

Conclusion: TEVAR in patients with acute aortic rupture has developed as an excellent treatment modality with good outcomes. Perioperative radiation exposure is minimal, but patients require thorough follow-up ideally in an aortic clinic with full cardiovascular and thoracic surgical expertise.

Publication History

Article published online:
19 February 2021