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Objective:Thoracic endovascular aortic repair (TEVAR) is now the preferred method of repair for most aortic pathology. This report explores the indications, morbidity, and long-term implications of TEVAR in patients under 45 years old.
Methods:This is a retrospective, single-institution study of electronic medical records for all patients under age 45 years treated with TEVAR from July 2006 to December 2022. Data collected included demographics, comorbidities, and 30-day and long term outcomes, including medical and aortic-related complications.
Results:The study cohort consisted of 30 patients, mean age 32 years, 22 males (73.3%), 10 (33.3%) with hypertension, and 15 (50%) were smokers. There were 16 (53.3%) traumatic disruptions, 1 (3.3%) aneurysm, 1 (3.3%) penetrating atherosclerotic ulcer, and 12 (40%) dissections (7 Type A and 5 Type B). Three patients died within 30 days of their procedure for a perioperative mortality rate of 10%; the interval from procedure to death was a mean 4.3 days (SD ± 3.8). Twenty-one had at least 1 follow-up visit post-TEVAR and 22 underwent at least one follow-up imaging study. Thirty-day morbidity overall was 50% and included endoleak in 6 (20%), cardiac complications in 5 (16.7%), renal failure in 7 (23.3%), spinal cord ischemia in 1 (3.3%), graft failure in 1 (3.3%), limb ischemia in 3 (10%), and multi-system organ failure in 3 (10%). Of the 22 patients with follow-up imaging, endovascular reinterventions were required in 4 (18.2%), while open surgical reintervention was necessary in 1 (4.5%). Reinterventions occurred at a median of 3.7 months postoperatively (0.7-60.8) and were indicated for 1 expanding aneurysm, 3 endoleaks, and 1 for combined endoleak and expanding aneurysm. There was one late death at 1.1 months (aortic-related) and another deceased patient whose cause and date of death are unknown.
Conclusion: Historically, patients that undergo TEVAR for underlying aortic pathologies, especially young patients, are followed long-term to monitor for further aortic degeneration and possible reintervention. In our study, majority of all reinterventions (80%) occurred within 1 year. However, all patients with traumatic aortic disruption who underwent TEVAR did not require any reintervention upon follow-up imaging. These patients may not require surveillance past one year

Publication Date

3-2024

Keywords

TEVAR, thoracic endovascular aortic repair, young patients

Disciplines

Surgery | Translational Medical Research

Comments

Society for Clinical Vascular Surgeons 51st Annual Symposium, March 16-20, 2024, Scottsdale, AZ

Trends in Thoracic Endovascular Aortic Repair in Patients 45 Years Old and Younger

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