Long term outcomes of TEVAR for Thoracic Aneurysms - A single center study

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Aims and objective: Thoracic Aortic Aneurysm (TAA) involves Ascending Aorta (40%) followed by DTA (35%), Aortic Arch (15%) and Thoraco-abdominal aneurysms(10%). TEVAR (Thoracic Endovascular Aneurysm Repair) is the standard of care for DTA and arch aneurysm, having mortality and morbidity advantages over surgical repair. Thoracic aortic diameter >5.5 cms, saccular aneurysm, growth of aneurysm >1 cm/year and symptomatic/ ruptured aneurysm were indications for repair. Existing literature shows excellent short term outcome of TEVAR for arch and DTA aneurysms, however literature regarding long term (>10 years) outcomes of TEVAR are scarce. Results: Technical success rate was 99%. Incidence of intra-procedural Type I endoleak was <10 % cases. On table aneurysm rupture/ dissection was seen in <2% cases. Neurological complications of embolic stroke and post-procedural para-plegia was seen in <5% cases. On long term CT follow-up, aneurysm sac regression was seen in about 70% cases, Type II endoleak and delayed Type I endoleak were observed in around 10% and 5% of cases respectively. Larger aneurysm size, Zone 0 proximal landing and increased aortic tortuosity were predictors of endoleak and re-intervention. Emergency TEVAR was associated with increased incidence of endoleak, neurological complications and mortality. Conclusions: TEVAR has a favourable outcome with respect to aneurysm sac regression. Our study is one of the first studies in the country, assessing the long term outcomes of TEVAR for arch and DTA aneurysms.