3 years ago

Operated descending thoracic and thoracoabdominal atherosclerotic aortic aneurysm prognosis

Antoine Monnot, Bruno Pochulu, Fabien Doguet, Sylvie Godier, Vincent Scherrer, Didier Plissonnier

Publication date: September 2018

Source: JMV-Journal de Médecine Vasculaire, Volume 43, Issue 5

Author(s): Antoine Monnot, Bruno Pochulu, Fabien Doguet, Sylvie Godier, Vincent Scherrer, Didier Plissonnier

Summary
Background

The long-term survival of patients treated from descending thoracic aneurysm (DTA) is well known, more than those treated from a thoracoabdominal aortic aneurysm (TAAA). Moreover, studies are rarely focused on the aneurysmal etiology and include both degenerative and post dissecting aneurysms. The aim of this study is to compare the long-term survival of patients operated from DTA or TAAA due to degenerative atherosclerosis.

Methods

Thirty-nine atherosclerotic aneurysm patients were operated between January 2007 and July 2015 at Rouen University Hospital. Eighteen DTA patients were operated by TEVAR and 21 TAAA patients (8 type I and 13 type III) by open approach. The main endpoint was remote survival patients.

Results

Overall, the initial population was similar in the two groups. However, one third of DTA were treated in context of emergency for painful aneurysm versus 9.5% of patients with TAAA (P = 0.066). Survival median of 18 DTA was 18 months (1–68). Survival median of 21 TAAA followed was 66 months (1–91). Survival in both groups was statistically different with the log-rank test (P = 0.044).

Conclusions

Long-term prognosis of atherosclerotic DTA may be worse than that of TAAA's. This retrospective study reflects experience in the management of DTA and TAAA in a single-center. Prospective data in patients treated with endovascular procedures for DTA or TAAA, with fenesterated or branched endoprosthesis, are warranted to confirm these results.

Résumé
Contexte

La survie à long terme des patients opérés d’un anévrisme aortique thoracique descendant (DTA) est mieux connue que ceux traités pour un anévrisme thoraco-abdominal (TAAA). Les études se concentrent rarement sur l’étiologie anévrismale et confondent les anévrismes dégénératifs et post-dissections. L’objectif de cette étude est de comparer la survie à long terme des patients opérés d’un DTA et d’un TAAA d’étiologie athéromateuse.

Méthodes

Trente-neuf patients atteints d’un anévrisme athéromateux ont été opérés entre janvier 2007 et juillet 2015 au CHU de Rouen. Dix-huit DTA ont été opérés par TEVAR et 21 patients TAAA (8 type I et 13 type III) par approche chirurgicale ouverte. Le critère de jugement principal était la survie à distance des patients opérés.

Résultats

La population initiale était globalement similaire dans les deux groupes. La médiane de survie des 18 DTA était de 18 mois (1–68). La médiane de survie des 21 TAAA était de 66 mois (1–91). La survie dans les deux groupes était statistiquement différente avec le test log-rank (p = 0,044).

Conclusion

Parmi l’étiologie athéromateuse, le pronostic à long terme des DTA pourrait être différent de celui des TAAA.

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