What are
the outcomes following thoracic endovascular aortic repair?
Endovascular repair may be a viable option for
repair of thoracic aortic pathology. Dake et al. (1994) reported 6 month, 1
year, and 2 year survival rates of 86%, 81%, and 73% respectively after
endovascular thoracic aortic aneurysm repair. The predictors of death were:
patients who were not surgical candidates, the use of cardiopul-monary bypass
(which was used in patients who underwent combined ascending aortic and arch
surgery with endovas-cular thoracic aortic aneurysm repair), patients with
large aneurysms or large aneurysm neck diameters, and older age. The major complications
of the procedure were early death (9%), neurologic (10%), and pulmonary (12%).
The 9% endovascular mortality was not much different from the reported 11%
mortality incidence of open repair. However, it should be noted that 16% of the
endovascular patients were operated on an emergency basis and 60% of these
patients were not candidates for open repair. In this context, a 9% mortality
rate is not unreasonable. It was suggested that the high incidence of stroke
might be caused by catheter or sheath manipulations in the aortic arch and
ascending aorta, excessive anticoagulation, or possibly surgical manipulation
of the carotid or subcla-vian arteries.
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