Comparative Outcomes of Thoracic Endovascular Aortic Repair versus Open Surgical Repair for Descending Thoracic Aortic Aneurysms: A Retrospective Cohort Analysis

Introduction: Descending Thoracic Aortic Aneurysms (DTAAs) pose significant management challenges, with Thoracic Endovascular Aortic Repair (TEVAR) increasingly replacing Open Surgical Repair (OSR) due to its minimally invasive nature. However, debates persist regarding long-term outcomes, durability, and optimal patient selection between these approaches. Aim: The present study aimed to compare perioperative and long-term outcomes of TEVAR versus OSR for DTAAs over a 10- year period focusing on mortality, complications, reinterventions and survival. Materials and Methods: The present retrospective cohort analysis was conducted on 133 consecutive patients (TEVAR: n=91; OSR: n=42) treated at a tertiary aortic center in Central India (2015-2025). Data collection included preoperative demographics, procedural details, and outcomes (30-day mortality, complications, reinterventions, and survival). Statistical analyses employed Kaplan-Meier survival analysis, Cox regression, and propensity score matching to adjust for confounders. Results: TEVAR demonstrated superior perioperative outcomes, with significantly lower rates of respiratory failure (p<0.01) and Acute Kidney Injury (AKI) (p=0.02), along with a trend toward reduced 30-day mortality (3.3% vs 9.5%, p=0.18). At 5-year follow-up, TEVAR showed better overall survival (80.1% vs 58.3%, p=0.042) but required more reinterventions (34.7% vs 0%, p<0.01). Multivariable analysis identified age {Hazard Ratio (HR) 1.05/year} and renal insufficiency (HR 2.12) as independent mortality predictors, while treatment modality showed no significant association (p=0.39). Conclusion: TEVAR provides superior early safety and intermediate-term survival, making it ideal for high-risk patients, while OSR offers greater durability for younger patients. Treatment selection should be individualised based on patient risk profile and anatomic suitability.