Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202401472
Jornal Vascular Brasileiro
Original Article

Long-term outcome of endovascular repair of thoracic and abdominal aortic diseases: a retrospective cohort study of 101 patients from a tertiary care centre

Desfechos a longo prazo do reparo endovascular de doenças da aorta torácica e abdominal: um estudo de coorte retrospectivo de 101 pacientes em um centro de cuidados terciários

Rajesh Vijayvergiya; Basant Kumar; Lipi Uppal; Ashish Sharma; Ajay Savlania; Ankush Gupta; Harkant Singh; Manphool Singhal

http://dx.doi.org/10.1590/1677-5449.202401472 J Vasc Bras, vol.24, e20240147, 2025
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Abstract

Background: Thoraco-abdominal endovascular aortic repair [(T)EVAR] of thoracic (TEVAR) and abdominal aorta (EVAR) has surpassed open surgical repair for thoraco-abdominal aortic diseases.

Objectives: We describe the long-term outcomes of 101 (T)EVAR patients treated over the last eleven years.

Methods: A retrospective analysis of 101 consecutive (T)EVAR patients was performed. The primary endpoints were in-hospital and 30-day outcomes, while the secondary endpoints were long-term outcomes and re-intervention rates.

Results: Out of 101 patients, EVAR and TEVAR were performed in 40 (39.6%) and 61 (60.3%) patients, respectively. Mean age was 58.04 ± 15.7 years. Technical success rates were 100% and 95% in the EVAR and TEVAR groups, respectively. Intraoperative endoleak was observed in 17 patients. Major perioperative complications (n=16) included retrograde aortic dissection (n=1), stent graft migration (n=2), paraparesis (n=1), device system entrapment in iliac vessels (n=1), acute renal failure (n=2), acute limb ischemia (n=3), and aorto-enteric fistula (n=2). The 30-day mortality rate was 7.9% (8 patients). Kaplan Meyer survival estimates at 1 and 5 years were 79% (95% CI 66.0-87.0, SE 0.053%) and 71% (95%CI 56.0- 81.0, SE 0.065%) for TEVAR and 84% (95% CI 67.0-92.0, SE 0.061%) and 69% (95%CI 46.0-83.0, SE 0.094%) for EVAR, respectively. Diabetes and smoking were associated with increased all-cause mortality in EVAR (p=0.018) and TEVAR (p=0.045) cases, respectively, following Cox regression analysis.

Conclusions: We observed favorable short- and long-term outcomes in 101 (T)EVAR patients, proving its safety and long-term efficacy for management of thoracoabdominal aortic disease.

Keywords

endovascular repair of abdominal aorta (EVAR); thoracic endovascular aortic repair (TEVAR); (thoracoabdominal) endovascular aortic repair [(T)EVAR]

Resumo

Contexto: Os reparos endovasculares da aorta torácica (TEVAR) e da aorta abdominal (EVAR) superaram a cirurgia aberta no tratamento das doenças da aorta toracoabdominal.

Objetivos: Descrever os desfechos a longo prazo de 101 pacientes submetidos a TEVAR e EVAR nos últimos 11 anos.

Métodos: Foi realizada uma análise retrospectiva de 101 pacientes consecutivos submetidos a TEVAR/EVAR. Os desfechos primários foram os resultados intra-hospitalares e aos 30 dias, enquanto os desfechos secundários incluíram os resultados a longo prazo e as taxas de reintervenção.

Resultados: Dos 101 pacientes, EVAR e TEVAR foram realizados em 40 (39,6%) e 61 (60,3%), respectivamente. A idade média foi de 58,04±15,7 anos. A taxa de sucesso técnico foi de 100% no grupo EVAR e de 95% no grupo TEVAR. Vazamento interno intraoperatório foi observado em 17 pacientes. As principais complicações perioperatórias (n=16) incluíram dissecção aórtica retrógrada (n=1), migração da endoprótese (n=2), paraparesia (n=1), aprisionamento do sistema do dispositivo nos vasos ilíacos (n=1), insuficiência renal aguda (n=2), isquemia aguda de membros (n=3) e fístula aortoentérica (n=2). A mortalidade aos 30 dias foi registrada em oito (7,9%) pacientes. As estimativas de sobrevida de Kaplan-Meier em 1 e 5 anos foram, respectivamente: 79% (IC95% 66,0-87,0; SE 0,053%) e 71% (IC95% 56,0-81,0; SE 0,065%) no grupo TEVAR; e 84% (IC95% 67,0-92,0; SE 0,061%) e 69% (IC95% 46,0-83,0; SE 0,094%) no grupo EVAR. Diabetes e tabagismo foram associados a um aumento da mortalidade por todas as causas nos grupos EVAR (p=0,018) e TEVAR (p=0,045), respectivamente, após análise de regressão de Cox.

Conclusões: Observamos desfechos favoráveis a curto e longo prazo em 101 pacientes submetidos a TEVAR/EVAR, comprovando sua segurança e eficácia a longo prazo no tratamento das doenças da aorta toracoabdominal.

Palavras-chave

Reparação endovascular da aorta abdominal (EVAR); reparação endovascular da aorta torácica (TEVAR); reparação endovascular da aorta (toracoabdominal) [(T)EVAR]

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Submitted date:
12/21/2024

Accepted date:
05/11/2025

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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