Thirty-Day Outcomes of Endovascular Repair of Non-Ruptured Thoracic Aneurysms in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background:

Thoracic Endovascular Aortic Repair (TEVAR) is the preferred treatment for thoracic aneurysms for eligible patients. Chronic obstructive pulmonary disease (COPD) is a common comorbidity that shares common inflammatory pathways with atherosclerosis, the major cause of thoracic aneurysms. However, surgical outcomes of TEVAR among patients with COPD have not been thoroughly investigated. This study aimed to assess the 30-day postoperative outcomes for COPD patients who have undergone TEVAR for non-ruptured thoracic aortic aneurysms, using data from a multi-institutional national registry.

Methods:

Patients who underwent TEVAR for non-ruptured thoracic aneurysms were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2022. A 1:1 propensity-score matching was used to match demographics, preoperative characteristics, and anesthesia between COPD and non-COPD patients. Thirty-day mortality and other postoperative outcomes were compared.

Results:

There were 525 (20.2%) COPD and 2,071 (79.8%) non-COPD patients who underwent TEVAR for the non-ruptured thoracic aneurysm. COPD was significantly more prevalent among patients with thoracic aneurysms compared to its incidence in the general population, and COPD patients also exhibited a higher burden of comorbidities. After 1:1 propensity-score matching, COPD and non-COPD patients had comparable 30-day mortality (5.7% vs 4.8%, p = 0.58). All other 30-day outcomes were comparable in COPD patients.

Conclusion:

While COPD might be linked to the development of thoracic aneurysms through potentially shared pathophysiological pathways, COPD does not appear to be related to major adverse 30-day outcomes in TEVAR. Future studies should aim to explore the long-term outcomes in COPD patients undergoing TEVAR.

Clinical Impact

COPD was significantly more prevalent among patients with thoracic aneurysms compared to the general population, and COPD patients also exhibited a higher burden of comorbidities. However, after propensity-score matching, COPD patients demonstrated comparable risks across all 30-day outcomes. Therefore, while COPD might be linked to the development of thoracic aneurysms through potentially shared pathophysiological pathways, COPD does not appear to be related to major adverse 30-day outcomes in TEVAR.