A Comparison of Clinical Outcomes of Endovascular Repair Versus Open Surgery for Ruptured Descending Thoracic Aorta

Abstract

Objective:

The comparisons between thoracic endovascular aortic repair for ruptured thoracic aorta (TEVAR) and open surgery (OS) have not been well documented, although both procedures have been widely utilized. We performed a systematic review and meta-analysis to investigate the effectiveness and safety between TEVAR and OS in the repair of ruptured descending thoracic aorta.

Methods:

PubMed, Embase, and Cochrane Library databases were searched to find relevant studies to assess TEVAR and OS outcomes. The comparative parameters were perioperative mortality (30 day/in-hospital), 1 year mortality, paraplegia or paraparesis, renal insufficiency, stroke, pulmonary embolism, re-intervention rate, pulmonary complications, and cardiac complications. A fixed-effects model was applied to calculate the odds ratio (OR) with a 95% confidence interval (CI) on pooled outcomes from different studies.

Results:

Eighteen observational trials involving 2088 patients were evaluated (TEVAR=560; OS=1528). Meta-analysis showed that TEVAR in repairing the ruptured descending thoracic aorta was associated with lower perioperative mortality (OR=0.47; 95% CI: 0.34–0.66; p<0.01), 1 year mortality (OR=0.46; 95% CI: 0.29–0.75; p<0.01), renal insufficiency incidence (OR=0.56; 95% CI: 0.33–0.93; p=0.03), and pulmonary complications (OR=0.69; 95% CI: 0.52–0.92; p=0.01) when compared with OS. There was no significant difference between TEVAR and OS in terms of paraplegia, stroke, pulmonary embolism, cardiac complications, and early re-intervention rates. However, the late re-intervention rate was higher in the TEVAR group than that in the OS group.

Conclusions:

When repairing the ruptured descending thoracic aorta, TEVAR may be performed rapidly and safely. TEVAR is associated with lower rates of perioperative morbidity and early postoperative complications than OS.

Keywords

thoracic aortic rupture open surgery thoracic endovascular aortic repair clinical outcome

Get full access to this article

View all access options for this article.

References

Wyss

Brown

Powell

, et al. Rate and predictability of graft rupture after endovascular and open abdominal aortic aneurysm repair: data from the EVAR Trials. Ann Surg. 2010;252(5):805–812.

Buz

Zipfel

Mulahasanovic

, et al. Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture. Eur J Cardiothorac Surg. 2008;33(2):143–149.

Vidal-Gonzalez

Mussan-Chelminsky

Kunz-Martinez

, et al. Endoluminal treatment for traumatic aortic rupture. Cir Cir. 2007;75(4):297–302.

de Cillis

Paradiso

Elmeghory

, et al. Endovascular treatment of traumatic descending aortic lesions: nine years of experience. Surg Technol Int. 2010;19:155–164.

Lamme

de Jonge

Reekers

, et al. Endovascular treatment of thoracic aortic pathology: feasibility and mid-term results. Eur J Vasc Endovasc Surg. 2003;25(6):532–539.

Kato

Dake

Miller

, et al. Traumatic thoracic aortic aneurysm: treatment with endovascular stent-grafts. Radiology. 1997;205(3):657–662.

Nzewi

Slight

Zamvar

Management of blunt thoracic aortic injury. Eur J Vasc Endovasc Surg. 2006;31(1):18–27.

Semba

Kato

Kee

, et al. Acute rupture of the descending thoracic aorta: repair with use of endovascular stent-grafts. J Vasc Interv Radiol. 1997;8(3):337–342.

Zhu

, et al. Secondary aortoesophageal fistula after thoracic aortic aneurysm endovascular repair: literature review and new insights regarding the hypothesized mechanisms. Int J Clin Exp Med. 2014;7(10):3244–3252.

10.

Azizzadeh

Ray

Dubose

, et al. Outcomes of endovascular repair for patients with blunt traumatic aortic injury. J Trauma Acute Care Surg. 2014;76(2):510–516.

11.

Dubose

Azizzadeh

Estrera

, et al. Contemporary management of blunt aortic trauma. J Cardiovasc Surg (Torino). 2015;56(5):751–762.

12.

Amabile

Collart

Gariboldi

, et al. Surgical versus endovascular treatment of traumatic thoracic aortic rupture. J Vasc Surg. 2004;40(5):873–879.

13.

Ott

Stewart

Lawlor

, et al. Management of blunt thoracic aortic injuries: endovascular stents versus open repair. J Trauma. 2004;56(3):565–570.

14.

Doss

Wood

Balzer

, et al. Emergency endovascular interventions for acute thoracic aortic rupture: four-year follow-up. J Thorac Cardiovasc Surg. 2005;129(3):645–651.

15.

Lebl

Dicker

Spain

, et al. Dramatic shift in the primary management of traumatic thoracic aortic rupture. Arch Surg. 2006;141(2):177–180.

16.

Stampfl

Greitbauer

Zimpfer

, et al. Mid-term results of conservative, conventional and endovascular treatment for acute traumatic aortic lesions. Eur J Vasc Endovasc Surg. 2006;31(5):475–480.

17.

Akowuah

Baumbach

Wilde

, et al. Emergency repair of traumatic aortic rupture: endovascular versus conventional open repair. J Thorac Cardiovasc Surg. 2007;134(4):897–901.

18.

Kokotsakis

Kaskarelis

Misthos

, et al. Endovascular versus open repair for blunt thoracic aortic injury: short-term results. Ann Thorac Surg. 2007;84(6):1965–1970.

19.

Riesenman

Farber

Rich

, et al. Outcomes of surgical and endovascular treatment of acute traumatic thoracic aortic injury. J Vasc Surg. 2007;46(5):934–940.

20.

Kauvar

White

Johnson

, et al. Endovascular versus open management of blunt traumatic aortic disruption at two military trauma centers: comparison of in-hospital variables. Mil Med. 2009;174(8):869–873.

21.

Patel

Williams

Upchurch

, et al. A comparative analysis of open and endovascular repair for the ruptured descending thoracic aorta. J Vasc Surg. 2009;50(6):1265–1270.

22.

Schmidli

Widmer

Basile

, et al. Editor’s choice—Vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.

23.

Liberati

Altman

Tetzlaff

, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W65-W94.

24.

Cindy

Sabrina

Kim

, et al. Traumatic aortic rupture: 30 years of experience. Ann Vasc Surg. 2011;25(4):474–480.

25.

Irace

Laurito

Venosi

, et al. Mid- and long-term results of endovascular treatment in thoracic aorta blunt trauma. ScientificWorldJournal. 2012;2012:396873.

26.

Lettinga-van de Poll

Schurink

De Haan

, et al. Endovascular treatment of traumatic rupture of the thoracic aorta. Br J Surg. 2007;94(5):525–533.

27.

Harky

Bleetman

Chan

, et al. A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta. J Vasc Surg. 2020;71(1):270–282.

28.

Buth

Harris

Hobo

, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. J Vasc Surg. 2007;46(6):1103–1110; discussion 10–1.

29.

Kotelis

Bischoff

Jobst

, et al. Morphological risk factors of stroke during thoracic endovascular aortic repair. Langenbecks Arch Surg. 2012;397(8):1267–1273.

30.

von Allmen

Gahl

Powell

JT.

Editor’s choice—incidence of stroke following thoracic endovascular aortic repair for descending aortic aneurysm: a systematic review of the literature with meta-analysis. Eur J Vasc Endovasc Surg. 2017;53(2):176–184.

31.

Sullivan

Sundt

III . Complications of thoracic aortic endografts: spinal cord ischemia and stroke. J Vasc Surg. 2006;43(suppl A):85A–88A.

32.

Xenos

Bietz

Davenport

DL.

Endoluminal versus open repair of descending thoracic aortic rupture: a review of the National Trauma Databank. Ther Adv Cardiovasc Dis. 2011;5(5):221–225.

33.

Di Eusanio

Folesani

Berretta

, et al. Delayed management of blunt traumatic aortic injury: open surgical versus endovascular repair. Ann Thorac Surg. 2013;95(5):1591–1597.

34.

Leurs

Bell

Degrieck

, et al. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg. 2004;40(4):670–669; discussion 9–80.

35.

Feezor

Martin

Hess

, et al. Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair. Ann Thorac Surg. 2008;86(6):1809; discussion 14.

36.

Marone

Coppi

Melissano

, et al. Endovascular treatment of an early arch aneurysm rupture after open thoracoabdominal aortic repair. J Cardiovasc Surg. 2016;57(1):86–89.

37.

Piffaretti

Mariscalco

Bonardelli

, et al. Predictors and outcomes of acute kidney injury after thoracic aortic endograft repair. J Vasc Surg. 2012;56(6):1527–1534.

38.

Fairman

Tuchek

Lee

, et al. Pivotal results for the Medtronic Valiant Thoracic Stent Graft System in the VALOR II trial. J Vasc Surg. 2012;56(5):1222–1231.

39.

Eggebrecht

Nienaber

Neuhäuser

, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006;27(4):489–498.

40.

Faure

Canaud

Agostini

, et al. Reintervention after thoracic endovascular aortic repair of complicated aortic dissection. J Vasc Surg. 2014;59(2):327–333.

41.

Boufi

Patterson

Grima

, et al. Systematic review of reintervention after thoracic endovascular repair for chronic type B dissection. Ann Thorac Surg. 2017;103(6):1992–2004.

42.

Nienaber

Kische

Ince

, et al. Thoracic endovascular aneurysm repair for complicated type B aortic dissection. J Vasc Surg. 2011;54(5):1529–1533.

43.

Patterson

Holt

Nienaber

, et al. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation. 2013;127(1):24–32.

44.

Chen

Wang

Liao

, et al. Timing of intervention in blunt traumatic aortic injury patients: open surgical versus endovascular repair. Ann Vasc Surg. 2015;29(8):1559–1566.

45.

Alric

Hinchliffe

Wenham

, et al. Lessons learned from the long-term follow-up of a first-generation aortic stent graft. J Vasc Surg. 2003;37(2):367–373.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.39 MB

0.29 MB

0.59 MB