胸部下行大動脈径は胸部血管内大動脈修復後の予後不良の予測因子である

To evaluate the results of thoracic endovascular aortic repair (TEVAR) in large (diameter ≥7 cm) aneurysms of the descending thoracic aorta.

This cohort has been extrapolated from the prospective, observational (on-label and off-label), worldwide multicentre Global Registry for Endovascular Aortic Treatment (GREAT) (NCT01658787). Patients were divided into two groups based on the baseline aortic diameter: standard aneurysms (<7 cm), and larger aneurysms (≥7 cm). Primary outcomes were overall survival, and freedom from TEVAR-related reintervention. Secondary outcomes were freedom from aortic-related mortality (ARM), as well as from type 1 endoleaks, and cumulative risk of TEVAR-related infection and/or aorto-bronchial/oesophageal fistulization.

We analyzed 613 (80.4%) patients with standard aneurysms, and 149 (19.6%) with larger aneurysms. Demographic data and co-morbidities were not different between the groups. At the 4-to-6 years window, 496 (65.1%) patients remained under follow-up [standard, n = 409 (66.7%) vs large, n = 87 (58.4%); OR: 1.4, P = 0.056]. Large aneurysm diameter was independently associated with higher hazards for all-cause mortality (HR: 1.6, 95% CI: 1.19-2.20; P < 0.001), TEVAR-related reintervention (HR: 2.4, 95% CI: 1.52-3.65; P < 0.001), risk of ARM (HR: 2.2, 95% CI: 1.03-4.75; P = 0.026), cumulative risk of TEVAR-related infection/fistulization, and type 1 endoleaks was lower in larger aneurysms group (HR: 3.3, 95% CI: 1.89-5.65; P < 0.001).

Preoperative descending thoracic aortic diameter seems to be an important determinant of outcomes after TEVAR, where patients presenting with aortic diameter ≤ 7 cm showed more favorable long-term outcomes.