Prognostic Impact of Osteoporosis on Survival Following Endovascular Repair for Descending Thoracic Aortic Aneurysms

The prognostic impact of osteoporosis after thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (DTAA) remains unclear.

This retrospective single-center cohort included 215 patients who underwent primary TEVAR for DTAA between 2007 and 2019. Bone mineral density (BMD) was estimated using Hounsfield units (HU) at the 11th thoracic vertebra on preoperative computed tomography, and osteoporosis was defined as BMD <110 HU. Patients were stratified by osteoporosis status, and long-term outcomes were compared. Hazard ratios for all-cause mortality were analyzed using univariate and multivariate models.

Overall, 114 patients (53.0%) had osteoporosis. Patients with osteoporosis were older and had lower BMD than those without osteoporosis (age, 77.1 ± 6.7 vs. 71.2 ± 9.9 years; BMD, 72.2 ± 24.2 vs. 141.8 ± 27.9 HU; P < 0.0001). During a median follow-up of 68 months, overall survival was lower in patients with osteoporosis than in those without osteoporosis (5-, 7-, and 10-year survival, 69.0%, 64.0%, and 48.3% vs. 86.0%, 82.9%, and 76.9%; log-rank P = 0.0003). Freedom from aneurysm-related mortality was also lower in patients with osteoporosis (5-, 7-, and 10-year survival, 91.6%, 91.6%, and 82.6% vs. 97.9%, 97.9%, and 94.7%; log-rank P = 0.048). In multivariable Cox regression, osteoporosis was independently associated with all-cause mortality (hazard ratio, 2.05; 95% confidence interval, 1.16-3.63; P = 0.014).

Osteoporosis was independently associated with reduced long-term survival after TEVAR for DTAA. CT-assessed BMD may provide a practical imaging-based marker for estimating life expectancy in this population.