Mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR)

Abstract

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.