NEW YORK (Reuters Health) – When a thoracic aortic aneurysm ruptures, expedient endovascular repair in selected patients can save lives, an international group reports.

They point out in their report in Circulation for June 29 that ruptured aneurysms of the descending thoracic aorta, as opposed to the abdominal aorta, are rare. While endovascular management is known to improve survival in ruptured abdominal aortic aneurysm, the technique has only recently become available for ruptured thoracic aneurysms.

To assess the value of thoracic endovascular aortic repair (TEVAR), Dr. Bart E. Muhs, at Yale University School of Medicine in New Haven, Connecticut and colleagues in multiple centers looked at outcomes in 87 patients who underwent the procedure.

The ruptured aneurysm was successfully excluded during TEVAR in 95.4% of the patients.

The researchers found that the 30-day mortality rate was 18.4%. This risk was highest in patients presenting with hypovolemic shock (odds ratio 4.75; p=0.014) and with hemothorax (odds ratio 6.65; p=0.008) after adjusting for age.

TEVAR entailed considerable neurologic risk. Periprocedural stroke occurred in 7 patients, including 4 who died of stroke, and another 7 patients became paraplegic.

Leaking from the endovascular graft was another concern. Endoleak was seen in 16 cases (18.4%) within the first 30 days after TEVAR.

The median follow-up of patients who were alive at 30 days was 13 months. In that time, 4 more patients died and the estimated aneurysm-related mortality rate at 4 years was 25.4%.

Still, Dr. and colleagues conclude, “Endovascular repair of rDTAA (ruptured descending thoracic aortic aneurysm) is associated with encouraging results.” As they point out, most such patients die before ever reaching the hospital, and the fatality rate is thought to exceed 90%.

In an accompanying editorial, Dr. Joseph S. Coselli at the Texas Heart Institute in Houston, along with Dr. Raja R. Gopaldas, point out that the patients in this series were selected strictly on the basis that they could benefit from the procedure. “This is key to the success of TEVAR,” they state, “and any center contemplating the use of this modality for emergency DTAA repair should have such a protocol in place.”

Reference:

Circulation 2010;121:2718-2723.