Single center retrospective subgroup analysis of “primary aortic” (aneurysm, aortic dissection, PAU) and “secondary aortic” (iatrogenic, trauma and aortoesophageal fistula) indications for emergency TEVAR

Abstract

Abstract Background The aim of the study was to analyse the outcome of emergency thoracic endovascular aortic repair (TEVAR) in the treatment of “primary aortic” (aneurysm, aortic dissection, penetrating aortic ulcer [PAU]) and “secondary aortic” (iatrogenic, trauma and aortoesophageal fistula) pathologies. Methods Retrospective review of a cohort of patients treated at a single tertiary referral center from 2015 to 2021. Primary end point was postoperative in-hospital mortality. Secondary end points were the duration of the procedure, duration of postoperative intensive care treatment, length of hospital stay, and the nature and severity of postoperative complications according Dindo-Clavien Classification Results A total of 34 patients underwent TEVAR for emergency indications. 22 patients were treated for primary and 12 patients for secondary aortic pathologies. Concerning in-hospital mortality, no statistically significant difference could be observed between the primary and secondary aortic groups (27.3% vs 33.3%, p = 0.711). Patients with aortoesophageal fistula had a mortality rate of 66.7%. Postoperative morbidity (Dindo-Clavien > 3) was also not statistically significant different between the aortic and non-aortic groups (36.4% vs 33.3%, p = 0.86). Preoperative hemoglobin level (mmol/L) (p < 0.001), postoperative creatinine level (umol/L) (p = 0.009) and pre- and postoperative lactate levels (p < 0.001) were found to be independent factors associated with early mortality and morbidity (Dindo-Clavien > 3). Conclusions Morbidity and in-hospital mortality are still considerable after emergency TEVAR, for both aortic and non-aortic indications. Pre- and postoperative levels of hemoglobin, creatinine and lactate may be valuable to predict the patient outcomes.