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Endovascular repair of thoracic aneurysm
has demonstrated low risks of mortality and
spinal cord ischemia (SCI), but few large series
have been published on endovascular
thoracoabdominal aneurysm repair, and reports
suffer from a lack of accurate comparison with
similar open surgical procedures.
A consecutive cohort of patients with thoracic and
thoracoabdominal aneurysms treated electively
with endovascular repair (ER) or surgical repair
(SR) techniques between 2001 and 2006 were
analyzed. The association between repair
technique and SCI was evaluated with univariable
analysis. Adjustments for potential confounders
and for the propensity to receive ER or SR were
also performed in multivariable analysis. A
total of 724 patients (352 ER, 372 SR) underwent
repair. The mean age was 67 years, and 65% were
male. ER patients were on average 9 years older
(P<0.001), had more comorbid conditions, and
more frequently had prior distal repair (P <
0.001) or underwent a type I or IV repair. SR
patients more commonly had chronic dissection or
required type II or type III repairs (P <
0.001). Mortality at 30 days (5.7% ER versus
8.3% SR, P = 0.2) and 12 months (15.6% ER versus
15.9% SR, P = 0.9) was similar. A borderline
difference in SCI was found between repair
techniques: 4.3% of ER and 7.5% of SR patients
(P=0.08) had SCI. In patients with ER, prior
distal aortic operation was associated with the
development of SCI in univariable analysis (odds
ratio 4.1, 95% confidence interval 1.4 to 11.7).
Multivariable analysis showed that the type of
required repair (type I, II, III, or IV) was the
primary factor associated with the development
of SCI in ER and SR patients.
No significant difference in the incidence of mortality
or SCI was found between ER and SR techniques.
The strongest factor associated with SCI remains
the extent of the disease. Further studies are
indicated to compare ER with patients considered
eligible for SR.
Circulation. 2008;118:808-817
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