Μεσοπρόθεσμα και μακροπρόθεσμα αποτελέσματα της τοποθέτησης ενδαγγειακών προθέσεων στη θωρακική αορτή

Abstract

Objective: Surveillance for patients undergoing Thoracic Endovascular AorticRepair (TEVAR) for Blunt Thoracic Aortic Injury (BTAI) varies. Empiricalrecommendation of annual chest CTA is often suggested. Concerns over risks andcosts have emerged. Evaluation of optimal follow-up frequency is attempted,based on 11-years outcomes and surveillance experience.Methods: 76 patients with BTAI received TEVAR from May 2002 to July 2013.Demographics, cardiovascular risk factors and Injury Severity Score (ISS), types,sizes, timing and outcomes of stent-grafts were retrospectively collected.Results: Mean age: 39.7 years (17-85), 8 (11%) females. Mean ISS: 46.2+/-18.5(deceased: 61.0+/-19.2, surviving: 44.2+/-17.6, p=0.023). Technical success: 71(93.4%). Mortality, all-cause: 7 (9.2%), of which, one (1.3%) was procedurerelated.Lost in follow-up: 6 (8%). To examine the effect of surveillance frequencyon outcomes, after excluding the 2 most recent (<1 year) surviving patients, wearbitrarily divided the remaining 61, with stable repairs, on the basis of theirfollow-up timing; 36: timely (+/- 6 months annual due visit) follow-up (clinical,CTA/MRA/echocardiogram). 25: delayed (>6 months annual due visit). Nosignificant differences found on survival, graft-related complications, need for reintervention,except from persistent hypertension, higher in 1st group. Allsurviving patients: excellent outcomes, no CVAs, paraplegia/paraparesis, medianfollow-up, both groups: 3 years (IQR 2.0-3.5, 1.5-5.4 years).Conclusions: Mid-term outcomes of TEVAR for BTAI patients with stable repairare excellent, both with timely (1.0-1.5 years) and delayed (>1.5 years) follow-upintervals at a median surveillance of 3 years. A larger prospective randomizedstudy could lead to a more relaxed, but equally safe surveillance schedule forthese patients, lowering both risks and costs.