Resumo

QUINTAS, Anita et al. Endovascular treatment for thoracic aortic pathology: an institutional experience. Angiol Cir Vasc [online]. 2016, vol.12, n.1, pp.03-11. ISSN 1646-706X.  https://doi.org/10.1016/j.ancv.2015.12.002.

Introduction: Endovascular treatment of the thoracic aorta is a technique which has revolutionized the treatment of different aortic pathologies. Objectives: Our purpose is to evaluate our institutional experience Methods: We present a retrospective analysis of a consecutive series of patients who underwent TEVAR at our Instituition. Patients who received fenestrated/branched abdominal devices were excluded. Results: From April 2005 to Abril 2014, 79 patients with a mean age of 66 ± 12.83 years (range 14 to 86) underwent TEVAR. The indications included: 46 thoracic aortic aneurysms (TAA) (58%), 17 aortic dissections (AD) Stanford B (22%), 13 due to other acute aortic syndromes (AAS) (16%), 2 due to atheroembolism (3%) e 1 due to an aortic-esophageal fistula (1%). The aortic aneurysms were located to the ascending aortic and arch in 5 cases (11%), the descending thoracic aorta in 35 (76%) and the thoracoabdominal aorta in 6 (13%). Mean aneurysm diameter was 69.64 mm (max 150 mm). Rupture was the clinical presentation in 21.5% of the patients (n = 17). 20.9% of the patients had previous aortic surgery. TEVAR was performed for acute complicated Stanford type B AD in 13 patients (76%) and for chronic AD in 4 (24%). AD-related complications included aneurysmatic dilatation in 35% (n = 6), organ malperfusion in 47% (n = 8). The Petticoat technique was performed in 9 cases (41.2%) and adjuvant procedures were necessary in 18% (renal artery stenting in 2; iliac artery stenting in 1). Regarding the other AAS, TEVAR was performed due to penetrating aortic ulcer in 4 cases, intra-mural hematome in 4 and in 5 cases due to rupture/pseudoaneurysm. The deployed endografts included 32 Valiant Medtronic^®, 15 TAG Gore^®, 25 Zenith TX2 Cook^®, 2 Zenith TX1 Cook^®, 1 Relay Plus^®, 3 Talent Medtronic^®. The median length of stay in the intensive care unit was 2 days (range 0-42) and median 2 units of erythrocytes was transfused per patient. Thirty-day/intrahospitalar mortality was 18% (n = 14). Mortality in elective procedures was 8% (4 in a total of 50) and 35% in urgent cases (10/29). Intraoperative additional interventions were required in 7 patients due to access vessel complications, in 2 due to iatrogenic AD, in 1 case due to acute limb thromboembolic ischemia and in 1 case to to a type IA endoleak. Reintervention rate was 17%, with the following indications: 9 endoleaks, 2 mesenteric ischemias and 2 aortic-esophageal fistulae. Conclusions: Our series represents an encouraging institutional experience, with reproducible outcomes. TEVAR is a safe and effective intervention for the management of different thoracic aortic pathologies, when compared to open surgery

Palavras-chave : Thoracic Endovascular Aortic Repair; Thoracic aortic aneurysm; Aortic dissection; Acute aortic syndrome; Rupture; Thoracic stentgraft; Endovascular treatment.

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