Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms

Frederik H W Jonker, Hence J M Verhagen, Peter H. Lin, Robin H. Heijmen, Santi Trimarchi, W. Anthony Lee, Frans L. Moll, Husam Atamneh, Vincenzo Rampoldi, Bart E. Muhs

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Ruptured descending thoracic aortic aneurysm (rDTAA) is a cardiovascular catastrophe, associated with high morbidity and mortality, which can be managed either by open surgery or thoracic endovascular aortic repair (TEVAR). The purpose of this study is to retrospectively compare the mortality, stroke, and paraplegia rates after open surgery and TEVAR for the management of rDTAA. Methods: Patients with rDTAA treated with TEVAR or open surgery between 1995 and 2010 at seven institutions were identified and included for analysis. The outcomes between both treatment groups were compared; the primary end point of the study was a composite end point of death, permanent paraplegia, and/or stroke within 30 days after the intervention. Multivariate logistic regression analysis was used to identify risk factors for the primary end point. Results: A total of 161 patients with rDTAA were included, of which 92 were treated with TEVAR and 69 with open surgery. The composite outcome of death, stroke, or permanent paraplegia occurred in 36.2% of the open repair group, compared with 21.7% of the TEVAR group (odds ratio [OR], 0.49; 95% confidence interval [CI], .24-.97; P = .044). The 30-day mortality was 24.6% after open surgery compared with 17.4% after TEVAR (OR, 0.64; 95% CI, .30-1.39; P = .260). Risk factors for the composite end point of death, permanent paraplegia, and/or stroke in multivariate analysis were increasing age (OR, 1.04; 95% CI, 1.01-1.08; P = .036) and hypovolemic shock (OR, 2.47; 95% CI, 1.09-5.60; P = .030), while TEVAR was associated with a significantly lower risk of the composite end point (OR, 0.44; 95% CI, .20-.95; P = .039). The aneurysm-related survival of patients treated with open repair was 64.3% at 4 years, compared with 75.2% for patients treated with TEVAR (P = .191). Conclusions: Endovascular repair of rDTAA is associated with a lower risk of a composite of death, stroke, and paraplegia, compared with traditional open surgery. In rDTAA patients, endovascular management appears the preferred treatment when this method is feasible.

Original languageEnglish
Pages (from-to)1210-1216
Number of pages7
JournalJournal of Vascular Surgery
Volume53
Issue number5
DOIs
Publication statusPublished - May 2011

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Thoracic Aortic Aneurysm
Aortic Rupture
Paraplegia
Thorax
Stroke
Odds Ratio
Confidence Intervals
Thoracic Surgery
Mortality
Aneurysm
Shock
Multivariate Analysis
Logistic Models
Regression Analysis
Morbidity
Survival
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Jonker, F. H. W., Verhagen, H. J. M., Lin, P. H., Heijmen, R. H., Trimarchi, S., Lee, W. A., ... Muhs, B. E. (2011). Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. Journal of Vascular Surgery, 53(5), 1210-1216. https://doi.org/10.1016/j.jvs.2010.10.135

Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. / Jonker, Frederik H W; Verhagen, Hence J M; Lin, Peter H.; Heijmen, Robin H.; Trimarchi, Santi; Lee, W. Anthony; Moll, Frans L.; Atamneh, Husam; Rampoldi, Vincenzo; Muhs, Bart E.

In: Journal of Vascular Surgery, Vol. 53, No. 5, 05.2011, p. 1210-1216.

Research output: Contribution to journalArticle

Jonker, FHW, Verhagen, HJM, Lin, PH, Heijmen, RH, Trimarchi, S, Lee, WA, Moll, FL, Atamneh, H, Rampoldi, V & Muhs, BE 2011, 'Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms', Journal of Vascular Surgery, vol. 53, no. 5, pp. 1210-1216. https://doi.org/10.1016/j.jvs.2010.10.135
Jonker FHW, Verhagen HJM, Lin PH, Heijmen RH, Trimarchi S, Lee WA et al. Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. Journal of Vascular Surgery. 2011 May;53(5):1210-1216. https://doi.org/10.1016/j.jvs.2010.10.135
Jonker, Frederik H W ; Verhagen, Hence J M ; Lin, Peter H. ; Heijmen, Robin H. ; Trimarchi, Santi ; Lee, W. Anthony ; Moll, Frans L. ; Atamneh, Husam ; Rampoldi, Vincenzo ; Muhs, Bart E. / Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. In: Journal of Vascular Surgery. 2011 ; Vol. 53, No. 5. pp. 1210-1216.
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abstract = "Background: Ruptured descending thoracic aortic aneurysm (rDTAA) is a cardiovascular catastrophe, associated with high morbidity and mortality, which can be managed either by open surgery or thoracic endovascular aortic repair (TEVAR). The purpose of this study is to retrospectively compare the mortality, stroke, and paraplegia rates after open surgery and TEVAR for the management of rDTAA. Methods: Patients with rDTAA treated with TEVAR or open surgery between 1995 and 2010 at seven institutions were identified and included for analysis. The outcomes between both treatment groups were compared; the primary end point of the study was a composite end point of death, permanent paraplegia, and/or stroke within 30 days after the intervention. Multivariate logistic regression analysis was used to identify risk factors for the primary end point. Results: A total of 161 patients with rDTAA were included, of which 92 were treated with TEVAR and 69 with open surgery. The composite outcome of death, stroke, or permanent paraplegia occurred in 36.2{\%} of the open repair group, compared with 21.7{\%} of the TEVAR group (odds ratio [OR], 0.49; 95{\%} confidence interval [CI], .24-.97; P = .044). The 30-day mortality was 24.6{\%} after open surgery compared with 17.4{\%} after TEVAR (OR, 0.64; 95{\%} CI, .30-1.39; P = .260). Risk factors for the composite end point of death, permanent paraplegia, and/or stroke in multivariate analysis were increasing age (OR, 1.04; 95{\%} CI, 1.01-1.08; P = .036) and hypovolemic shock (OR, 2.47; 95{\%} CI, 1.09-5.60; P = .030), while TEVAR was associated with a significantly lower risk of the composite end point (OR, 0.44; 95{\%} CI, .20-.95; P = .039). The aneurysm-related survival of patients treated with open repair was 64.3{\%} at 4 years, compared with 75.2{\%} for patients treated with TEVAR (P = .191). Conclusions: Endovascular repair of rDTAA is associated with a lower risk of a composite of death, stroke, and paraplegia, compared with traditional open surgery. In rDTAA patients, endovascular management appears the preferred treatment when this method is feasible.",
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AU - Jonker, Frederik H W

AU - Verhagen, Hence J M

AU - Lin, Peter H.

AU - Heijmen, Robin H.

AU - Trimarchi, Santi

AU - Lee, W. Anthony

AU - Moll, Frans L.

AU - Atamneh, Husam

AU - Rampoldi, Vincenzo

AU - Muhs, Bart E.

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N2 - Background: Ruptured descending thoracic aortic aneurysm (rDTAA) is a cardiovascular catastrophe, associated with high morbidity and mortality, which can be managed either by open surgery or thoracic endovascular aortic repair (TEVAR). The purpose of this study is to retrospectively compare the mortality, stroke, and paraplegia rates after open surgery and TEVAR for the management of rDTAA. Methods: Patients with rDTAA treated with TEVAR or open surgery between 1995 and 2010 at seven institutions were identified and included for analysis. The outcomes between both treatment groups were compared; the primary end point of the study was a composite end point of death, permanent paraplegia, and/or stroke within 30 days after the intervention. Multivariate logistic regression analysis was used to identify risk factors for the primary end point. Results: A total of 161 patients with rDTAA were included, of which 92 were treated with TEVAR and 69 with open surgery. The composite outcome of death, stroke, or permanent paraplegia occurred in 36.2% of the open repair group, compared with 21.7% of the TEVAR group (odds ratio [OR], 0.49; 95% confidence interval [CI], .24-.97; P = .044). The 30-day mortality was 24.6% after open surgery compared with 17.4% after TEVAR (OR, 0.64; 95% CI, .30-1.39; P = .260). Risk factors for the composite end point of death, permanent paraplegia, and/or stroke in multivariate analysis were increasing age (OR, 1.04; 95% CI, 1.01-1.08; P = .036) and hypovolemic shock (OR, 2.47; 95% CI, 1.09-5.60; P = .030), while TEVAR was associated with a significantly lower risk of the composite end point (OR, 0.44; 95% CI, .20-.95; P = .039). The aneurysm-related survival of patients treated with open repair was 64.3% at 4 years, compared with 75.2% for patients treated with TEVAR (P = .191). Conclusions: Endovascular repair of rDTAA is associated with a lower risk of a composite of death, stroke, and paraplegia, compared with traditional open surgery. In rDTAA patients, endovascular management appears the preferred treatment when this method is feasible.

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