Abstract

Aim: Thoracic endovascular aortic repair (TEVAR) is currently the preferred treatment for different pathologies of the thoracic aorta because of its technical advantages over open surgery. This single-center study analyzes early outcomes of TEVAR with a special focus on spinal cord ischemia (SCI) and reintervention rates and their relationship to patient and procedural variables.
Material and Methods: Data were retrospectively collected from patients who underwent TEVAR between February 2012 and August 2023. Patients were classified by pathology type: thoracic aortic aneurysms (n=97, 66.4%), type B aortic dissections (n=28,19.2%), traumatic aortic injuries (n=12, 8.2%), and other pathologies (n=9, 6.2%). Primary outcomes included SCI and reintervention rates at one year post-procedure; secondary outcomes included stroke, upper extremity ischemia, and 30-day mortality. The statistical analysis used univariate and multivariate logistic regression models as well as Kaplan-Meier survival analyses with subgroup comparisons between elective and urgent cases.
Results: A total of 146 patients were analyzed; 79.45% were male with an average age of 63.23±12.50 years. Of this population, 121 patients (82.9%) had elective procedures and 25 patients (17.2%) had urgent/emergent procedures; postoperative spinal cord ischemia developed in 11 patients (7.5%). The stroke rate was 13.7% (n=20).The 30-day mortality rate was significantly higher in patients undergoing urgent TEVAR compared to those undergoing elective procedures (32.0% vs. 13.2%, p=0.02). TEVAR-related reintervention was required within a year for 38 patients (26%).There are no independent predictors for spinal cord ischemia; however, the multivariate analysis shows that early reintervention has a strong association with diabetes mellitus (OR 3.2, 95% CI 1.3–7.8, p=0.01), history of smoking (OR 2.1, 95% CI 1.0–4.4, p=0.05), and lesions in distal zones (OR 2.4, 95% CI 1.1–5.2, p=0.03). Urgent cases showed a trend toward higher reintervention rates compared to elective procedures (40.0% vs. 23.1%, p=0.08).
Conclusion: This study demonstrates that the risk of reintervention is increased in cases with a history of diabetes mellitus, smoking, and aortic pathologies located in the distal thoracic zone. Urgent procedures carry higher morbidity and mortality risks but should be confirmed by larger randomized multicenter studies.

Key words: Thoracic aorta, endovascular procedures ,spinal cord ischemia, reintervention, aortic aneurysm