Long-Term Thoracic Endovascular Repair Follow-Up from 1999 to 2019: A Single-Center Experience

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Thoracic endovascular aortic repair (TEVAR) has been utilized since the early 1990s.
• Current guidelines emphasize the need for long-term follow-up studies.
• Understanding long-term outcomes is essential for optimizing TEVAR patient management.

Purpose of the Study:

• To evaluate the long-term outcomes of thoracic endovascular aortic repair (TEVAR).
• To compare mortality and reintervention rates between different thoracic aortic disease indications.
• To assess the incidence and timing of endoleaks and aneurysm growth post-TEVAR.

Main Methods:

• A prospective database of 256 patients undergoing TEVAR between 1999 and 2019 was analyzed.
• Patients with thoracic aortic aneurysms, dissection, traumatic rupture, PAU, and IMH were included.
• Primary endpoint was all-cause death; secondary endpoint was reintervention, with follow-up truncated at 15 years.

Main Results:

• Technical success was 94.1%. Thirty-day mortality was significantly higher for urgent (21.2%) versus elective (1.75%) TEVAR.
• Overall long-term mortality was 43.8%, with 11.3% requiring reintervention, mostly within the first 5 years.
• While initial mortality differences between acute and chronic aortic syndromes diminished over time, new endoleaks occurred even decades later.

Conclusions:

• TEVAR demonstrates acceptable long-term results, with initial survival differences between acute and chronic aortic syndromes narrowing over time.
• Most reinterventions and endoleaks occur within the first five years, but late occurrences necessitate lifelong surveillance.
• Lifelong surveillance is recommended for all patients following TEVAR due to the potential for late endoleak development.