Complications Following TEVAR For Ruptured Thoracic Aortic Aneurysms Remain High Compared With Elective Repair.

OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysm is associated with increased perioperative mortality and morbidity compared with intact repair. The purpose of this study was to evaluate factors associated with presentation of ruptured aneurysm and adverse outcomes following repair.

METHODS: The Vascular Quality Initiative (VQI) registry was queried (2010-2020) to identify patients who underwent TEVAR for ruptured and intact thoracic aortic aneurysm. The primary outcome was to identify factors associated with ruptured thoracic aortic aneurysm. Secondary outcomes included perioperative mortality and morbidity, five-year survival, and identification of factors associated with adverse outcomes after TEVAR.

RESULTS: Of 3,039 patients identified with thoracic aortic aneurysm, 2,806 (92%) underwent repair for intact aneurysm and 233 (8%) underwent repair for ruptured aneurysm. Chronic kidney disease (CKD) was associated with higher odds of presentation with ruptured aneurysm (OR 3.1; 95%CI [2.0-4.9]; P<.001). Factors associated with lower odds of rupture included prior aortic aneurysm repair (OR 0.71; 95%CI [.49-.97]; P=.05), prior smoker (OR 0.36; 95%CI [.24-.53]; P<.001), preoperative beta-blocker therapy (OR 0.57; 95%CI [.41-.80]; P=.001), and preoperative statin therapy (OR 0.68; 95%CI [.49-.94]; P=.020). TEVAR for ruptured thoracic aortic aneurysm was associated with higher perioperative mortality (rupture: 27% vs intact: 4.6%; OR 6.6; 95%CI [4.3-10]; P<.001) as well as composite mortality/new dialysis/paralysis/stroke (38% vs 9.5%; OR 5.1; 95%CI [3.5-7.4]; P<.001). Five-year survival was significantly lower following TEVAR for ruptured thoracic aortic aneurysm (50% vs 76%; P<.001; HR 0.39; 95%CI [.29-.52]; P<.001). Preoperative statin therapy was associated with higher five-year survival (HR 1.3; 95%CI [1.0-1.6]; P=.021).

CONCLUSION: TEVAR for ruptured thoracic aortic aneurysm results in increased perioperative mortality and morbidity as well as lower 5-year survival compared with repair for intact aneurysm. Patients with prior aortic aneurysm repair, prior smokers, and those on preoperative beta-blocker or statin therapy were less likely to present with ruptured thoracic aneurysm. This correlation might be attributed to increased exposure to cardiovascular healthcare providers and subsequently increased screening and surveillance, allowing for elective repair of thoracic aortic aneurysm.