Clinical outcomes of endovascular repair in ruptured aortic pathologies: A single center experience with TEVAR and EVAR procedures

Aim: Aortic ruptures are critical vascular emergencies with high mortality rates, typically involving the thoracic and abdominal regions. This study aims to evaluate the clinical outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Endovascular Aneurysm Repair (EVAR) procedures in patients with ruptured thoracic and abdominal aortic pathologies, focusing on mortality, morbidity, and complications. Material and Methods: This retrospective, single-center study included 32 patients treated with endovascular interventions for ruptured aortic pathologies between 2019 and 2024. Fourteen patients with thoracic aortic rupture received TEVAR, while eighteen with abdominal aortic rupture underwent EVAR. The causes of rupture were classified as aortic transection (due to trauma), type-3 dissection, aneurysm, pseudoaneurysm, aorto-enteric fistula, and iatrogenic perforation. Demographic and clinical data, procedural details, and post-operative outcomes were collected and analyzed. Results: The primary causes of rupture included aortic transection (50%) in the TEVAR group and aneurysm (56.2%) in the EVAR group. Mortality rates were 14.3% in the TEVAR group and 27.8% in the EVAR group, while morbidity rates were 7.1% and 16.7%, respectively. Intensive care unit (ICU) and ward stays were significantly longer in the TEVAR group. Follow-up imaging showed normal results in 100% of TEVAR patients and in 88.9% of EVAR patients; endoleak was observed in 11.1% of the EVAR group (p<0.05). In the logistic regression analysis, the presence of complications was identified as a significant risk factor for mortality (OR=3.06, 95% CI: 1.04–8.97; p=0.04). Conclusion: TEVAR and EVAR are effective endovascular treatment modalities that provide high efficacy and safety in managing ruptured aortic pathologies, especially in emergency settings. The capability to perform hybrid procedures promptly in urgent cases underscores the adaptability and rapid applicability of endovascular therapies. Despite the inherent challenges of ruptured aortic pathologies, our study emphasizes the clinical importance of TEVAR in thoracic and EVAR in abdominal aortic ruptures, offering valuable insights that enhance the current literature.