Nationwide outcomes of endovascular thoracoabdominal aortic aneurysm repair

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BACKGROUND: Complex endovascular repair has emerged as a minimally invasive alternative for thoracoabdominal aortic aneurysms (TAAAs). The aim of this study was to assess the short- and mid-term outcomes of endovascular TAAA repair in Sweden. METHODS: All endovascular TAAA repairs performed during 2018-2023 were identified in the Swedish Vascular (Swedvasc) Registry. Patient characteristics, operative details, and outcomes were analysed. The primary outcome was survival; secondary outcomes included complications and thoracoabdominal aortic life-altering events (TALEs). Predictors of mid-term outcomes were assessed in multivariable analysis. RESULTS: Some 339 patients were treated for TAAAs, which included 476 repairs (366 elective repairs and 110 emergency repairs) across 11 centres (94% concentrated in 5 centres). Elective patients (235 patients; mean diameter 64 mm) had 30-day, 90-day, and 1-year mortality of 2.6%, 3.5%, and 12.4% respectively. Major complications, vascular complications, and TALEs occurred in 16.2%, 9.8%, and 14% respectively. The use of prophylactic spinal drainage declined over time (from 68% to 14%) and the incidence of spinal cord ischaemia declined over time (from 20% to 2.3%). Mean(s.e.) 1-year and 4-year Kaplan-Meier survival estimates were 89.3%(2.1%) and 73.5%(3.7%) respectively. Emergency patients (104 patients; mean diameter 73 mm) had 30-day, 90-day, and 1-year mortality of 12.5%, 17.6%, and 26.9% respectively. Major complications, vascular complications, and TALEs occurred in 20.2%, 12.5%, and 24% respectively. Mean(s.e.) 1-year and 4-year Kaplan-Meier survival estimates were 75.2%(4.3%) and 56.5%(6.2%) respectively. Perioperative myocardial infarction was the strongest predictor of 1-year mortality after both elective and emergency repair. CONCLUSION: Endovascular TAAA repair in Sweden is associated with significant complication rates, but acceptable mid-term survival. Further research should focus on perioperative refinements, especially with regard to preserving organ function.

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