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Review

Endovascular versus open repair for descending thoracic aortic rupture: institutional experience and meta-analysis

University of Kentucky Medical Center, Department of Surgery, Lexington, KY, USA

Received 2 May 2008; received in revised form 14 October 2008; accepted 16 October 2008.

^_* Corresponding author. Address: University of Kentucky, Department of Surgery, 800 Rose Street, Lexington, KY 40536, USA. Tel.: +1 859 3236346x230; fax: +1 859 323 6840. (Email: esxeno2{at}email.uky.edu).

Rupture of thoracic aneurysm, acute type B dissection, blunt thoracic trauma, and penetrating aortic ulcer can present with a similar clinical profile of thoracic aortic rupture. We report a meta-analysis of comparative studies evaluating endoluminal graft versus open repair of these lesions as well as the early experience from our institution. We searched the following databases for reports of endovascular versus open repair of acute descending thoracic aortic rupture: Medline/PubMed, OVID, EMBASE, CINAHL, ClinicalTrials.gov, the Cochrane central register of controlled trials and the Cochrane database of systematic reviews. We used the random-effects model to calculate the odds ratio (OR) and 95% confidence intervals (CI) for mortality, paraplegia/paraparesis and stroke rates. Also, the medical records of the patients treated in our institution with this technique from 2000 to 2008 were reviewed. Demographics, comorbidities and operative procedure information were retrieved. Outcomes examined were mortality, paraplegia and stroke. Meta-analysis indicates that endoluminal graft repair is accompanied by lower procedure related mortality (OR 0.46, 95% CI 0.26–0.78, p = 0.005) and paraplegia rates (OR 0.23, 95% CI 0.08–0.65, p = 0.005), as compared to open repair. There was no difference in stroke rate between the two methods (OR 0.86, 95% CI 0.26–2.8, p = 0.8). We have treated 13 patients with endoluminal stent-grafts. No conversion to open repair was necessary. Stroke rate was15%, no patient died as a result of the stent-graft placement, one patient died as a result of massive head injury (overall 30-day mortality: 7.5%). There were no spinal cord ischemic complications. Our experience and meta-analysis indicate that thoracic endograft repair has low mortality and spinal cord complication rates for treatment of acute thoracic aortic rupture. If this method proves to be durable, it could replace open repair as the treatment of choice for these critically ill patients.

Key Words: Thoracic aortic rupture • Endoluminal repair

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