Descending Thoracic Aortic Aneurysms: Is There a New Plan A?

The last available evidence suggests that open surgery should be the preferred treatment for intact descending thoracic aortic aneurysms. However, this study recently published in J Am Coll Cardiol, seems to have steered the wheel.

screening aneurisma aorta abdominalIn this study, open surgery was associated to increased early mortality and lower late mortality. Despite this long-term benefit, mean survival favored endovascular repair. This evidence suggests endovascular repair should be the first choice when it comes to intact thoracic aortic aneurysms.

 

This retrospective analysis used propensity score matching to compare 1235 patients undergoing surgery against 2470 patients undergoing endovascular repair between 1999 and 2010, followed up until 2014. The study looked into perioperative mortality and survival. Reinterventions were among the secondary end points.


Read also: Several Features Define a Hostile Neck in AAA patients, but Only One Makes the Difference.


Periprocedural mortality was higher for the surgery group, with differences between high volume (OR: 1.97, CI 95% 1.53 to 2.61) and low volume centers (OR: 3.62 CI 95% 2.88 to 4.51), though this reversed by the end of the study. Despite early and late survival rates, mean survival after the 9-year follow-up was better with endovascular repair (p<0.001). Reintervention risk (a secondary end point) favored surgery.

 

Conclusion

Conventional surgery is associated with higher early mortality and lower late mortality compared against endovascular repair. After a 9-year follow-up, survival favors endovascular repair, which is why this should be the preferred course of action.

 

Original title: Endovascular Versus Open Repair of Intact Descending Thoracic Aortic Aneurysms.

Reference: Peter Chiu et al. J Am Coll Cardiol 2019;73:643–51.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....

Chronic Thromboembolic Pulmonary Hypertension: Treatment Outcomes According to a Worldwide Registry

Chronic thromboembolic pulmonary hypertension (CTEPH) is a highly limiting condition that, despite its moderate incidence, significantly impacts patient prognosis and quality of life. The...

Contemporary Outcomes of Acute Limb Ischemia Endovascular Revascularization

Acute limb ischemia (ALI) is a vascular emergency with high mortality rate. It has been defined as a sudden occlusion of limb perfusion compromising...

TCT 2024 | SIRONA: Randomized Study Comparing Sirolimus-Coated vs Paclitaxel-Coated Balloon Angioplasty in Femoropopliteal Disease

This prospective, randomized, multicenter, investigator-initiated non-inferiority study compared the use of sirolimus-coated balloon (MagicTouch) vs paclitaxel-coated balloon in endovascular treatment.  The primary objective was to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....