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Endovascular Repair of 100 Urgent and Emergent Free or Contained Thoracoabdominal Aortic Aneurysms Ruptures. An International Multicenter Trans-Atlantic Experience

Spath, Paolo ; Tsilimparis, Nikolaos ; Gallitto, Enrico ; Becker, Daniel ; Vacirca, Andrea ; Berekoven, Bärbel ; Panuccio, Giuseppe ; Karelis, Angelos LU orcid ; Kahlberg, Andrea and Melissano, Germano , et al. (2025) In Annals of Surgery 281(3). p.522-531
Abstract

Objective: To analyze the outcomes of urgent/emergent endovascular aortic repair of patients with free/contained ruptured thoracoabdominal aortic aneurysms (rTAAA). Background: Endovascular repair of rTAAA has been scarcely described in emergent setting. Methods: An international multicenter retrospective observational study (ClinicalTrials.govID:NCT05956873) from January 2015 to January 2023 in 6 European and 1 US Vascular Surgery Centers. Primary end points were technical success, 30-day and/or in-hospital mortality, and follow-up survival. Results: A total of 100 rTAAA patients were included (75 male; mean age 73 years). All patients (86 contained and 14 free ruptures) were symptomatic and treated within 24 hours from diagnosis:... (More)

Objective: To analyze the outcomes of urgent/emergent endovascular aortic repair of patients with free/contained ruptured thoracoabdominal aortic aneurysms (rTAAA). Background: Endovascular repair of rTAAA has been scarcely described in emergent setting. Methods: An international multicenter retrospective observational study (ClinicalTrials.govID:NCT05956873) from January 2015 to January 2023 in 6 European and 1 US Vascular Surgery Centers. Primary end points were technical success, 30-day and/or in-hospital mortality, and follow-up survival. Results: A total of 100 rTAAA patients were included (75 male; mean age 73 years). All patients (86 contained and 14 free ruptures) were symptomatic and treated within 24 hours from diagnosis: multibranched off-the-shelf devices (Zenith t-branch, Cook Medical Inc., Bjaeverskov, Denmark) in 88 patients, physician-modified endografts in 8, patient-specific device or parallel grafts in 2 patients each. Primary technical success was achieved in 89 patients, and 30-day and/or in-hospital mortality was 24%. Major adverse events occurred in 34% of patients (permanent dialysis and paraplegia in 4 and 8 patients, respectively). No statistical differences were detected in mortality rates between free and contained ruptured patients (43% vs 21%; P=0.075). Multivariate analysis revealed contained rupture favoring technical success [odds ratio (OR): 10.1; 95% CI: 3.0-33.6; P<0.001]. Major adverse events (OR: 9.4; 95% CI: 2.8-30.5; P<0.001) and pulmonary complications (OR: 11.3; 95% CI: 3.0-41.5; P<0.001) were independent risk factors for 30-day and/or in-hospital mortality. The median follow-up time was 13 months (interquartile range 5-24); 1-year survival rate was 65%. Aneurysm diameter >80 mm (hazard ratio: 2.0; 95% CI: 1.0-30.5; P=0.037), technical failure (hazard ratio: 2.6; 95% CI: 1.1-6.5; P=0.045) and pulmonary complications (hazard ratio: 3.0; 95% CI: 1.2-7.9; P=0.021) were independent risk factors for follow-up mortality. Conclusions: Endovascular repair of rTAAA shows high technical success; the presence of free rupture alone appear not to correlate with early mortality. Effective prevention/management of postoperative complications is crucial for survival.

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publication status
published
subject
keywords
endovascular repair, major adverse events, mortality, pulmonary complications, ruptured thoracoabdominal aortic aneurysm, survival, technical success
in
Annals of Surgery
volume
281
issue
3
pages
10 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85218497770
  • pmid:38323417
ISSN
0003-4932
DOI
10.1097/SLA.0000000000006231
language
English
LU publication?
yes
id
1417570e-ec88-44c3-8848-43828153d7cf
date added to LUP
2025-06-23 09:58:45
date last changed
2025-07-07 10:14:27
@article{1417570e-ec88-44c3-8848-43828153d7cf,
  abstract     = {{<p>Objective: To analyze the outcomes of urgent/emergent endovascular aortic repair of patients with free/contained ruptured thoracoabdominal aortic aneurysms (rTAAA). Background: Endovascular repair of rTAAA has been scarcely described in emergent setting. Methods: An international multicenter retrospective observational study (ClinicalTrials.govID:NCT05956873) from January 2015 to January 2023 in 6 European and 1 US Vascular Surgery Centers. Primary end points were technical success, 30-day and/or in-hospital mortality, and follow-up survival. Results: A total of 100 rTAAA patients were included (75 male; mean age 73 years). All patients (86 contained and 14 free ruptures) were symptomatic and treated within 24 hours from diagnosis: multibranched off-the-shelf devices (Zenith t-branch, Cook Medical Inc., Bjaeverskov, Denmark) in 88 patients, physician-modified endografts in 8, patient-specific device or parallel grafts in 2 patients each. Primary technical success was achieved in 89 patients, and 30-day and/or in-hospital mortality was 24%. Major adverse events occurred in 34% of patients (permanent dialysis and paraplegia in 4 and 8 patients, respectively). No statistical differences were detected in mortality rates between free and contained ruptured patients (43% vs 21%; P=0.075). Multivariate analysis revealed contained rupture favoring technical success [odds ratio (OR): 10.1; 95% CI: 3.0-33.6; P&lt;0.001]. Major adverse events (OR: 9.4; 95% CI: 2.8-30.5; P&lt;0.001) and pulmonary complications (OR: 11.3; 95% CI: 3.0-41.5; P&lt;0.001) were independent risk factors for 30-day and/or in-hospital mortality. The median follow-up time was 13 months (interquartile range 5-24); 1-year survival rate was 65%. Aneurysm diameter &gt;80 mm (hazard ratio: 2.0; 95% CI: 1.0-30.5; P=0.037), technical failure (hazard ratio: 2.6; 95% CI: 1.1-6.5; P=0.045) and pulmonary complications (hazard ratio: 3.0; 95% CI: 1.2-7.9; P=0.021) were independent risk factors for follow-up mortality. Conclusions: Endovascular repair of rTAAA shows high technical success; the presence of free rupture alone appear not to correlate with early mortality. Effective prevention/management of postoperative complications is crucial for survival.</p>}},
  author       = {{Spath, Paolo and Tsilimparis, Nikolaos and Gallitto, Enrico and Becker, Daniel and Vacirca, Andrea and Berekoven, Bärbel and Panuccio, Giuseppe and Karelis, Angelos and Kahlberg, Andrea and Melissano, Germano and Dias, Nuno and Kölbel, Tilo and Austermann, Martin and Faggioli, Gianluca and Oderich, Gustavo and Gargiulo, Mauro and Cappiello, Antonio and Tinaglia, Sarah and Mitta, Nivedita and Sufali, Gemmi and Karelias, Angelos}},
  issn         = {{0003-4932}},
  keywords     = {{endovascular repair; major adverse events; mortality; pulmonary complications; ruptured thoracoabdominal aortic aneurysm; survival; technical success}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{522--531}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Annals of Surgery}},
  title        = {{Endovascular Repair of 100 Urgent and Emergent Free or Contained Thoracoabdominal Aortic Aneurysms Ruptures. An International Multicenter Trans-Atlantic Experience}},
  url          = {{http://dx.doi.org/10.1097/SLA.0000000000006231}},
  doi          = {{10.1097/SLA.0000000000006231}},
  volume       = {{281}},
  year         = {{2025}},
}