Complicated Acute Aortic Syndromes Affecting the Descending Thoracic Aorta: Endovascular Treatment Compared With Open Repair

Background For patients with complicated acute thoracic aortic syndromes, endovascular treatment, when feasible, is preferred over open surgery. However, there are limited data on the long-term benefits of endovascular treatment in complicated acute aortic syndromes affecting the descending thoracic aorta. Hypothesis The endovascular treatment is expected to have more favorable long-term mortality and fewer late reintervention in complicated acute thoracic aortic syndromes. Methods Of 155 consecutive patients with acute aortic syndromes, 94 met the inclusion criteria of the study; 63 underwent endovascular repair (group 1) and 31 underwent open repair (group 2). Patients with a diagnosis of acute aortic syndrome localized in the descending thoracic aorta distal to the emergence of the left subclavian artery, complicated by rupture, malperfusion syndrome, and/or acute aortic expansion, were included. Indications for repair of the descending thoracic aorta included impending rupture in 70.2%, malperfusion syndrome in 29.8%, and persistence of pain with aortic expansion (aortic diameter >40 mm) in 2 patients. Results During the follow-up period (63.0 ± 24.6 months), the cumulative survival free from cardiovascular death rates at 5 years was 92.0% and 51.4% in group 1 and 2, respectively (log rank P = 0.0001). Late mortality related to the aorta was 1.6% with thoracic endovascular aortic repair and 0% with surgical treatment. Conclusions Endovascular treatment in patients with complicated acute thoracic aortic syndromes localized at the descending thoracic aorta is feasible and safe, with a lower rate of early complications and similar long-term benefits when compared with surgical treatment.