Organ ischemia after Thoracic Endovascular Aortic Repair.

OBJECTIVES: To evaluate incidence and outcomes of ischaemic organ complications after thoracic endovascular aortic repair (TEVAR).

METHODS: This is a multicentre, retrospective, observational cohort study. We analyzed data from patients treated with TEVAR between June 22nd 2001 and December 10th 2022. Primary outcomes were postoperative overall organ ischaemic complications and early (≤ 30 days) survival. Secondary outcomes were long-term survival, and freedom from aorta-related mortality (ARM).

RESULTS: A total of 255 patients were included in this study. We performed 233 (91.4%) isolated TEVARs, 14 (5.5%) fenestrated or branched TEVARs, and 8 (3.1%) TEVARs in combination with normal infrarenal stent graft. Overall, 31 organ ischaemic complications were detected in 29 (11.4%) cases, out of which 8 (3.1%) complications were cerebrovascular, 8 (3.1%) spinal cord, 6 (2.3%) visceral, 4 (1.6%) renal, 2 (0.8%) peripheral, and 3 (1.2%) myocardial. Binary logistic regression analysis identified grade III-IV aortic arch atheroma (OR: 6.6, P = 0.001; 95% CI: 2.9-14-9) and shaggy aorta (OR: 12.1, P = 0.003; 95% CI: 2.3-64.1) to be associated with the development of organ ischaemic complications. In patients with organ ischaemia, we observed higher early (≤ 30 days) mortality (20.7% vs 6.2%; OR: 3.6, P = 0.016), prolonged hospitalization (P = 0.001), and inferior estimated survival (Log-rank, P = 0.001).

CONCLUSIONS: Aortic arch atherosclerotic overload as well as the presence of shaggy aorta are predictors of organ ischaemic complications following TEVAR. They are neither uncommon nor negligible, and are associated with perioperative mortality, prolonged hospitalization, and a negative impact on long-term survival.