Estudio multicéntrico de la reparación endovascular urgente de la aorta torácica: indicaciones y resultados

Objective: Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery.Study design and scope: A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units.Patients, inclusion criteria: 1) Ruptured descending thoracic aortic aneurysms; 2) Blunt traumatic thoracic aortic injury; and 3) Complicated acute type B aortic dissections (TBADc). Primary variables: Patient mortality, survival and reoperation rate.Secondary variables: Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications.Results: A total of 135 urgent TEVARs were included (111 men, mean age 60.4 +/- 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the ruptured descending thoracic aortic aneurysms group (27.9%). The mean actuarial survival rate was 67 +/- 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%).Conclusions: Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality -though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain. (C) 2019 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.