Despite improvements in perioperative diagnosis, treatment and postoperative care, surgical repair of ruptured thoracic aortic aneurysms (r-TAA) has continued to have a high morbidity and mortality.
However, a new study of endovascular repair of r-TAA was associated with markedly reduced mortality and improved mid-term survival, when compared to open surgical approach in a prospective intent-to-treat longitudinal study by the Albany Vascular Group in Albany, N.Y. The results were presented at the Vascular Annual Meeting, June 5-8, in San Diego, Calif.
Since 2001, a total of 121 patients presented emergently with r-TAA at The Vascular Institute for Health and Disease, Albany Medical Center. Forty-three per cent of the patients underwent emergent thoracic endovascular aneurysm repair (TEVAR) and 57 per cent had emergent open surgical repair.
Compared to the open surgical group, the endovascular patients had significantly higher pre-existing defined comorbidities, including coronary artery disease (47 vs. 17 per cent), hypertension (69 vs. 30 per cent), chronic obstructive pulmonary disease (21 vs. four per cent) and chronic renal insufficiency (16 vs. four per cent). Neurological complications including paraplegia and stroke, also occurred more frequently in the open group (16 vs. five per cent). Over a mean follow-up of 15 months, 11 per cent of the patients in the endovascular group and 16 per cent of the patients in the open surgical group required secondary adjunctive procedures.
According to Manish Mehta, MD, associate professor of surgery and co-author of the study, use of endovascular techniques for emergent treatment of r-TAA increased annually from 29 per cent in 2005 to 67 per cent in 2006, up to 90 per cent in 2007. Prior to 2005, open surgical repair of r-TAA was the primary treatment of choice.
Surgeons at the Vascular Institute for Health and Disease said the ability to treat r-TAA by endovascular means has had a significant impact on improving patient survival. "The life table analysis indicated the cumulative survival in the endovascular group to be significantly better than the open surgical group--at 30 day, 71 vs. 44 per cent; one year, 51 vs. 33 per cent; two year, 45 vs.33 per cent; and three years, 45 vs. 26 per cent," said Dr. Mehta. "Besides improving on the morbidity and mortality of these complex high risk procedures, with an endovascular approach we can expand on offering this treatment to patients with significant co-morbidities who might otherwise been left untreated."
