Long-term results of endovascular repair in thoracic aortic pathologies: 14 years of single center experience

Aim: Although short- and medium-term efficacy and safety of endovascular interventions in thoracic aortic pathologies have been proven, their long-term results and effects on survival are still controversial. The main purpose of this study is to investigate the effects of pathology type, emergency and elective intervention, and accompanying diseases on long-term survival and development of complications in long-term follow-up. Material and Methods: A total of 142 patients who underwent Thoracic Endovascular Aortic Repair (TEVAR) between July 2010 and December 2024 were included. Retrospective analysis was performed. Patients were divided into groups as emergency and elective and also according to pathology type and analyses were performed. Primary outcome was determined as thoracic aortic pathology types and 5 and 14-year survival in emergency and elective patients, and secondary outcomes were determined as the effects of factors such as age, gender, and additional diseases on the development of complications and survival. Statistical significance was determined as p value <0.05. Results: A total of 156 stents were implanted in 142 patients in the study. While 58 (40.84%) of the patients were in the emergency group, 84 (59.15%) were evaluated in the elective group. While the 5 and 14-year survival rates of elective cases were found to be significantly higher than those of emergency cases (p=0.037, p=0.046), the average survival time of aneurysm cases was found to be significantly higher than those of other groups in the analysis performed according to pathology types (p=0.023). No significant relationship was found between gender and the development of endoleaks and complications (p<0.001). It was observed that the presence of diabetes increased the risk of complications by 16.2 times (OR=16.257, CI=2.709-97.575, p<0.01), and the presence of PAH increased the risk by 10.1 times (OR=10.187, CI=1.373-75.578, p=0.02). Conclusion: TEVAR continues to be an effective and safe treatment for both emergency and elective thoracic aortic pathologies. Close monitoring is required due to the long survival expectation and the risk of re-intervention. We recommend TEVAR as the first choice for the treatment of all thoracic aortic pathologies.