Descending thoracic aortic diameter is a predictor of poor outcome after endovascular aortic repair

Abstract OBJECTIVES To evaluate the results of thoracic endovascular aortic repair (TEVAR) in large (diameter ≥7 cm) aneurysms of the descending thoracic aorta. METHODS This cohort has been extrapolated from the prospective, observational (on-label and off-label), worldwide multicentre Global Registry for Endovascular Aortic Treatment (GREAT) (NCT01658787). Patients were divided into two groups based on the baseline aortic diameter: standard aneurysms (7 cm), and larger aneurysms (≥7 cm). Primary outcomes were overall survival, and freedom from TEVAR-related reintervention. Secondary outcomes were freedom from aortic-related mortality (ARM), as well as from type 1 endoleaks, and cumulative risk of TEVAR-related infection and/or aorto-bronchial/oesophageal fistulization. RESULTS We analyzed 613 (80.4%) patients with standard aneurysms, and 149 (19.6%) with larger aneurysms. Demographic data and co-morbidities were not different between the groups. At the 4-to-6 years window, 496 (65.1%) patients remained under follow-up standard, n = 409 (66.7%) vs large, n = 87 (58.4%); OR: 1.4, P = 0.056. Large aneurysm diameter was independently associated with higher hazards for all-cause mortality (HR: 1.6, 95% CI: 1.19–2.20; P 0.001), TEVAR-related reintervention (HR: 2.4, 95% CI: 1.52–3.65; P 0.001), risk of ARM (HR: 2.2, 95% CI: 1.03–4.75; P = 0.026), cumulative risk of TEVAR-related infection/fistulization, and type 1 endoleaks was lower in larger aneurysms group (HR: 3.3, 95% CI: 1.89–5.65; P 0.001). CONCLUSIONS Preoperative descending thoracic aortic diameter seems to be an important determinant of outcomes after TEVAR, where patients presenting with aortic diameter ≤ 7 cm showed more favorable long-term outcomes.