BACKGROUND: We evaluated mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR). METHODS: Between 1996 and 2009, 421 patients underwent TEVAR for the following indications: atherosclerotic aneurysms, type B dissections, penetrating ulcers and traumatic lesions. RESULTS: Twenty-one patients underwent secondary surgical interventions. Indications were type I endoleak formation, retrograde type A dissection, distal aneurysm formation as well as infection. Retrospectively, by analysing referral computed tomography scans and by current knowledge, failure could have been foreseen in 72% of patients. Median interval to secondary surgical intervention was 24 months (IQR 8-40). Sixteen patients underwent thoracic or thoracoabdominal repair and five patients underwent ascending and hemiarch replacement. In-hospital mortality was 19%. Cause of death was multiorgan failure in all cases. CONCLUSIONS: The need for secondary surgical intervention after TEVAR is low but carries risk. By analysing mechanisms of failure, the majority of these events could have been avoided by a more strict indication. Thereby, further critical evaluation and respecting limitations of TEVAR will help to reduce the need for these operations.
BACKGROUND: We evaluated mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR). METHODS: Between 1996 and 2009, 421 patients underwent TEVAR for the following indications: atherosclerotic aneurysms, type B dissections, penetrating ulcers and traumatic lesions. RESULTS: Twenty-one patients underwent secondary surgical interventions. Indications were type I endoleak formation, retrograde type A dissection, distal aneurysm formation as well as infection. Retrospectively, by analysing referral computed tomography scans and by current knowledge, failure could have been foreseen in 72% of patients. Median interval to secondary surgical intervention was 24 months (IQR 8-40). Sixteen patients underwent thoracic or thoracoabdominal repair and five patients underwent ascending and hemiarch replacement. In-hospital mortality was 19%. Cause of death was multiorgan failure in all cases. CONCLUSIONS: The need for secondary surgical intervention after TEVAR is low but carries risk. By analysing mechanisms of failure, the majority of these events could have been avoided by a more strict indication. Thereby, further critical evaluation and respecting limitations of TEVAR will help to reduce the need for these operations.
Authors: Julia Dumfarth; Hannes Dejaco; Christoph Krapf; Thomas Schachner; Heinz Wykypiel; Thomas Schmid; Johann Pratschke; Michael Grimm Journal: Aorta (Stamford) Date: 2014-02-01
Authors: Jesus M Matos; Kim I de la Cruz; Maral Ouzounian; Ourania Preventza; Scott A LeMaire; Joseph S Coselli Journal: Tex Heart Inst J Date: 2014-04-01
Authors: Martin Czerny; Tobias König; David Reineke; Gottfried H Sodeck; Maximilian Rieger; Florian Schoenhoff; Reto Basciani; Hansjörg Jenni; Jürg Schmidli; Thierry P Carrel Journal: Interact Cardiovasc Thorac Surg Date: 2013-06-19
Authors: Stoyan Kondov; Leon Frankenberger; Matthias Siepe; Cornelius Keyl; Klaus Staier; Frank Humburger; Bartosz Rylski; Maximilian Kreibich; Tim Berger; Friedhelm Beyersdorf; Martin Czerny Journal: Interact Cardiovasc Thorac Surg Date: 2022-08-03
Authors: Ivancarmine Gambardella; George A Antoniou; Francesco Torella; Cristiano Spadaccio; Aung Y Oo; Mario Gaudino; Francesco Nappi; Matthew A Shaw; Leonard N Girardi Journal: J Am Heart Assoc Date: 2017-09-13 Impact factor: 5.501