Endovascular Thoracic Aneurysm Repair Deemed Safer Than Open Surgery

Endovascular, noninvasive thoracic aortic aneurysm repair (TEVAR) is safer than open aneurysm repair (OAR) as it is associated with fewer cardiac, respiratory, and hemorrhagic complications, according to a new study.

Researchers at the University of Michigan Medical School (Ann Arbor, USA) reviewed data from a large, unselected sampling of the U.S. National Inpatient Sample (NIS) database that represents the entire scope of unruptured thoracic aortic aneurysm repairs in the United States. The researchers examined complications, mortality, hospital stay, hospital charges, patient disposition, discharge status, and patient demographics. Data was collected on 267 patients who underwent TEVAR and 1,030 patients who underwent OAR; the average ages were 66 years for OAR patients and nearly 70 years for TEVAR.


The researchers found that patients who underwent TEVAR had a higher burden of cardiovascular comorbidities, and were more likely to suffer from hypertension, renal insufficiency, chronic obstructive pulmonary disease (COPD), cerebrovascular occlusive disease, and peripheral artery disease (PAD). The researchers also found that OAR had a higher overall complication rate (33% versus 20%). More TEVAR patients were discharged from the hospital within the first few days of their procedure, and a significant number of OAR patients were hospitalized for more than 10 days. The two approaches were equivalent in their rates of in-hospital mortality and iatrogenic cerebrovascular accident; however, hematoma development, postoperative infections, and cardiac, respiratory, and hemorrhagic complications were more likely to occur in OAR patients. The study was published in the May 2009 issue of the Journal of Vascular Surgery.

"Our NIS data does not report long term complications of TEVAR such as endoleak, stent migration, and stent fracture which are known to occur frequently after discharge,” said lead author Gilbert Upchurch, Jr., M.D., of the department of surgery. "However, studies of midterm follow-up for TEVAR show that the real concern for death lies in the immediate perioperative period before hospital discharge, suggesting that our mortality rate accurately captures the bulk of repair-related deaths.”

Thoracic aortic aneurysms (TAAs) are aneurysms, which involve the ascending aorta, aortic arch, and descending thoracic aorta. Fifty percent of patients who experience a rupture of a thoracic aortic aneurysm die before reaching the hospital; furthermore, surgical repair of a ruptured thoracic aneurysm carries 25-50% mortality as opposed to a mortality rate of 5-8% when such aneurysms are treated electively. The operation also is fraught with complications, including paralysis and renal failure.

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