Journal of thoracic disease · 2025
Endovascular treatment outcomes for descending thoracic aortic pathologies in octogenarians: retrospective study.
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Al-Osail Emad M, Porto Alizee, De Masi Mariangela, Omnes Virgile, Jacquier Alexis, Piquet Philippe, Gaudry Marine
Аннотация
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has become the reference treatment for thoracic diseases in high-risk patients. Regarding the aging of the population, the indications for TEVAR in octogenarians are constantly increasing with little data on the results of this treatment in this population. The aim of this study was to evaluate the short- and medium-term results of TEVAR for descending thoracic aorta diseases in octogenarians' patients.
METHODS: In a single-center retrospective study, patients aged 80 years and older who underwent TEVAR for descending thoracic aortic aneurysm or dissection between 2000 and 2021 were included. Demographic data, perioperative morbi-mortality, mortality risk factors, and anatomical results were analyzed using the latest available scanner during follow-up.
RESULTS: In this study from 2000-2021, 35 octogenarians' patients (57% men, 43% women) underwent treatment for thoracic aortic pathologies, 74% were treated for aneurysm, 26% for aortic dissection and 34% required urgent surgery (10 ruptures, 2 malperfusions). Technical success was 100%, with 14.0% intra-hospital mortality (4 respiratory distress, 1 cardiac arrest). Morbidity rate was 42% (7 respiratory complications, 2 paraplegias, 2 strokes, 3 renal failures). After 14 months of follow-up, death rate was 20% (6/30). Aortic diameter analysis showed stable lesions in 69.2% (n=18), regression in 26.9% (n=7), and increased diameter in 3.8% (n=1). Type I endoleaks were observed in 8.6% (n=3), type 2 in 11.4% (n=4).
CONCLUSIONS: Endovascular treatment of descending thoracic aortic pathologies in patients aged 80 and older carries higher risks. Careful patient selection is crucial, and therapeutic abstention may be a viable option for this population.
METHODS: In a single-center retrospective study, patients aged 80 years and older who underwent TEVAR for descending thoracic aortic aneurysm or dissection between 2000 and 2021 were included. Demographic data, perioperative morbi-mortality, mortality risk factors, and anatomical results were analyzed using the latest available scanner during follow-up.
RESULTS: In this study from 2000-2021, 35 octogenarians' patients (57% men, 43% women) underwent treatment for thoracic aortic pathologies, 74% were treated for aneurysm, 26% for aortic dissection and 34% required urgent surgery (10 ruptures, 2 malperfusions). Technical success was 100%, with 14.0% intra-hospital mortality (4 respiratory distress, 1 cardiac arrest). Morbidity rate was 42% (7 respiratory complications, 2 paraplegias, 2 strokes, 3 renal failures). After 14 months of follow-up, death rate was 20% (6/30). Aortic diameter analysis showed stable lesions in 69.2% (n=18), regression in 26.9% (n=7), and increased diameter in 3.8% (n=1). Type I endoleaks were observed in 8.6% (n=3), type 2 in 11.4% (n=4).
CONCLUSIONS: Endovascular treatment of descending thoracic aortic pathologies in patients aged 80 and older carries higher risks. Careful patient selection is crucial, and therapeutic abstention may be a viable option for this population.