OBJECTIVE

To study the immediate and long-term results of thoracic aortic endovascular repair (TEVAR) and conservative therapy for thoracic aortic aneurysms and dissections.

MATERIAL AND METHODS

We analyzed the results (n=80) of TEVAR and conservative therapy for thoracic aortic dissection and aneurysms. TEVAR was performed in 52 patients, conservative therapy — in 28 patients. Patients with dissections comprised 69% (n=36) and 57% (n=16), respectively. Mean follow-up period was 2.7±0.3 years.

RESULTS

There were no significant differences in mortality and morbidity. In-hospital mortality was absent in both groups; 30-day mortality was 2% (n=1) and 4% (n=1), respectively. Long-term mortality rates were also comparable (12% (n=6) and 22% (n=6), respectively). No significant difference was found. Cumulative freedom from all endoleaks was 92% (95% CI 0.795—0.98), from dSINE — 96% (95% CI 0.80—0.986), from stent-graft migration and aneurysm expansion — 100%. Analysis of rates after TEVAR depending on thoracic aortic lesion showed that 30-day survival rate was 94% in the aneurysm group and 100% in the aortic dissection group (p=0.48). Subsequently, survival rate after TEVAR for aneurysms was 94% until three-year follow-up. After TEVAR for aortic dissections, 12-month survival rate was 89%, 3-year survival — 86%.

CONCLUSION

Endovascular repair for thoracic aortic aneurysms and dissections is highly effective in early and long-term period. Compared to conservative therapy of uncomplicated aortic lesions, TEVAR demonstrates comparable short- and long-term clinical results. Despite the lack of significant difference in the outcomes, the percentage of positive aortic remodeling is higher after TEVAR. This trend suggests more favorable long-term outcomes, possible statistical difference in long-term period and necessary further study of this issue.