A multicenter study of emergency endovascular repair of the thoracic aorta: indications and outcomes

Med Intensiva (Engl Ed) . Jun-Jul 2021;45(5):280-288. doi: 10.1016/j.medin.2019.10.008. Epub 2019 Dec 10.

Fecha de la publicación: 10/12/2019

Autor: C López Espada (1), J P Linares Palomino (2), J M Domínguez González (3), E Iborra Ortega (4), P Lozano Vilardell (5), T Solanich Valldaura (6), G Volo Pérez (7), E Blanco Cañibano (8), A Álvarez Salgado (9), J C Fernández Fernández (10), M Hernando Rydings (11), M Miralles Hernández (12)

Palabras clave: Aneurisma aórtico, Aortic aneurysm, Aortic dissection, Disección aórtica, Emergency endovascular repair, Endograft, Endoprótesis, Enfermedades de aorta torácica, Mortalidad; Mortality, Reparación endovascular urgente, Thoracic aortic disease, Traumatic aortic rupture, Traumatismo aórtico



1Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, España. Electronic address: clegra3@hotmail.com.

2Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, España.

3Servicio de Cirugía Vascular, Hospital Universitari Vall d’Hebron, Barcelona, España.

4Servicio de Cirugía Vascular, Hospital Universitari de Bellvitge, Barcelona, España.

5Servicio de Cirugía Vascular, Hospital Universitari Son Espases, Palma de Mallorca, España.

6Servicio de Cirugía Vascular, Corporació Sanitaria Parc Tauli, Sabadell, España.

7Servicio de Cirugía Vascular, Hospital Universitario Dr. Negrín, Gran Canaria, Espa


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.