Thoracic Endovascular Aortic Repair : Clinical and morphological outcomes

Sammanfattning: In the years following its introduction in the late 1980’s, thoracic endovascular aortic repair (TEVAR) rose as a minimally invasive alternative to open surgical repair of thoracic aortic disease. As a result, an expanding group of patients are receiving invasive treatment, even though evidence in the area is still scarce. The overall aim of this thesis was to study the outcomes of modern treatment of thoracic aortic disease – TEVAR and hybrid repair – by analyzing data from local and international cohorts.Paper I includes an evaluation of outcomes of TEVAR for intact and ruptured thoracic aortic aneurysm (TAA) at a tertiary referral center (1999 to 2014). Survival was unexpectedly poor after ruptured TAA repair, only one third of the patients were alive at 3-years follow-up. Intact TAA repair was associated with low perioperative mortality and acceptable 5-year survival.Paper II analyses aortic remodelling, complications, reinterventions and survival after TEVAR for subacute and chronic type B aortic dissection at a tertiary aortic center (1999-2015). TEVAR induced positive remodelling, characterized by false lumen thrombosis and shrinkage accompanied by true lumen expansion, of the thoracic but not the abdominal aorta. Reintervention due to aortic dilatation distal to the stent graft was common.Paper III, an international registry-based multicenter study of 9518 TEVAR cases from 2012 to 2016, demonstrated substantial international differences in practice patterns. The large dataset provides a point of reference for short-term outcome after TEVAR in current practice.   Paper IV, a single-center study of 50 consecutive patients who underwent frozen elephant trunk repair of the aortic arch (2006 to 2020), confirmed that whilst this procedure is associated with morbidity and mortality, the technique provides an adequate bridge to endovascular repair of the downstream aortic segments, which was common during follow-up. The repair was shown to induce positive aortic remodeling in the thoracic but not abdominal aorta, in patients with chronic aortic dissection.In conclusion, this thesis provides insights into the rapidly evolving field of TEVAR, including an overview of current practice as well as clinical and morphological outcomes.