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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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