Instabilities in Aortic Length after TEVAR and Reoperation: 12 Years of Follow-up Imaging.

BACKGROUND: TEVAR remains an important minimally invasive tool for the treatment of descending thoracic aneurysm. The long term effects of these repairs in both reduction of the aneurysmal sac size as well as stability of the stented portion require study. We report the results of 12 years of radiographic follow-up.

METHODS: All patients with TEVAR for descending thoracic aneurysms from January 2005 to December 2017(n=371) were evaluated for immediate postoperative and follow-up CT scans suitable for 3D reconstruction of the aorta(excluding those with an interim reoperation). 62 patients were found meeting these criteria(median duration of radiographic follow-up:1.8 years). Measurements were taken of centerline, greater and lesser curvatures from the most distal patent brachiocephalic vessel to the first uncovered mesenteric vessel, as well as between proximal and distal edges of the stented portion of the aorta.

RESULTS: All measured segments except covered length were found to be significantly increasing in length for centerline, greater and lesser curvatures, with a median increase of 7.6(IQR:1.7-16) mm. Cox regression for mortality and reoperation found no significant correlation between these changes and mortality, and a significant correlation between stented segment greater curvature increase and reoperation(Adjusted HR:1.06, P<0 .05).

CONCLUSIONS: Increases in the centerline and greater curve length of the aorta was found to be occurring. This appears to be primarily driven by growth in the non-stented segments. However, changes in the outer curve length of the stented segment were found to be associated with greater risk of reoperation.