Multicentre experience of antegrade thoracic endovascular aortic repair for the treatment of thoracic aortic diseases

Lorenzo Gibello; Michele Antonello; Efrem Civilini; Quentin Pellenc; Raffaello Bellosta; Luciano Carbonari; Stefano Bonardelli; Antonio Freyrie; Vincent Riambau; Gianfranco Varetto; Fabio Verzini

doi:10.1093/ejcts/ezae185

Multicentre experience of antegrade thoracic endovascular aortic repair for the treatment of thoracic aortic diseases

Eur J Cardiothorac Surg. 2024 May 3;65(5):ezae185. doi: 10.1093/ejcts/ezae185.

Authors

Affiliations

¹ Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
² Section of Vascular and Endovascular Surgery, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
³ Humanitas University Department of Biomedical Sciences, Humanitas University, Milan, Italy.
⁴ Department of Thoracic and Vascular Surgery, Marfan Syndrome National Referral Center, Bichat University Hospital, APHP, Paris, France.
⁵ Vascular and Endovascular Surgery Division, La Cote HealthCare Group, Morges, VD, Switzerland.
⁶ Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.
⁷ Vascular Surgery Unit, Lancisi Cardiovascular Center, Ancona, Italy.
⁸ Vascular Surgery, Department of Surgery, Spedali Civili University Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy.
⁹ Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
¹⁰ Department of Vascular Surgery, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.

PMID: 38733578
DOI: 10.1093/ejcts/ezae185

Abstract

Objectives: The goal of this multicentre retrospective cohort study was to evaluate technical success and early and late outcomes of thoracic endovascular repair (TEVAR) with grafts deployed upside down through antegrade access, to treat thoracic aortic diseases.

Methods: Antegrade TEVAR operations performed between January 2010 and December 2021 were collected and analysed. Both elective and urgent procedures were included. Exclusion criteria were endografts deployed in previous or concomitant surgical or endovascular repairs.

Results: Fourteen patients were enrolled; 13 were males (94%) with a mean age of 71 years (interquartile range 62; 78). Five patients underwent urgent procedures (2 ruptured aortas and 3 symptomatic patients). Indications for treatment were 8 (57%) aneurysms/pseudoaneurysms, 3 (21%) dissections and 3 (21%) penetrating aortic ulcers. Technical success was achieved in all procedures. Early mortality occurred in 4 (28%) cases, all urgent procedures. Median follow-up was 13 months (interquartile range 1; 44). Late deaths occurred in 2 (20%) patients, both operated on in elective settings. The first died at 19 months of aortic-related reintervention; the second died at 34 months of a non-aortic-related cause. Two patients (14%) underwent aortic-related reinterventions for late type I endoleak. The survival rate of those having the elective procedures was 100%, 84% and 67% at 12, 24 and 36 months, respectively. Freedom from reintervention was 92%, 56% and 56% at 12, 24 and 36 months, respectively.

Conclusions: Antegrade TEVAR can seldom be considered an alternative when traditional retrograde approach is not feasible. Despite good technical success and few access-site complications, this study demonstrates high rates of late type I endoleak and aortic-related reinterventions.

Keywords: Aortic arch; Endoleak; Endovascular; TEVAR; Thoracic aorta; Thoracic endovascular repair.

Publication types

Multicenter Study

MeSH terms

Aged
Aorta, Thoracic* / surgery
Aortic Aneurysm, Thoracic / mortality
Aortic Aneurysm, Thoracic / surgery
Aortic Diseases* / surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / methods
Endovascular Aneurysm Repair
Endovascular Procedures* / methods
Female
Humans
Male
Middle Aged
Postoperative Complications / epidemiology
Retrospective Studies
Treatment Outcome