• Peter A Naughton, Michael S Park, Mark D Morasch, Heron E Rodriguez, Manuel Garcia-Toca, C Edward Wang, and Mark K Eskandari.
• Division of Vascular Surgery, Northwestern University, 676 N St Clair, Ste 650, Chicago, IL 60611, USA.
• Arch Surg. 2012 Mar 1; 147 (3): 243-9.

ObjectiveTo provide a contemporary institutional comparative analysis of expedient correction of acute catastrophes of the descending thoracic aorta (ACDTA) by traditional direct thoracic aortic repair (DTAR) or thoracic endovascular aortic repair (TEVAR).DesignSingle-center retrospective review (April 2001-January 2010).SettingAcademic medical center.PatientsOne hundred patients with ACDTA treated with either TEVAR (n = 76) or DTAR (n = 24). Indications for repair included ruptured degenerative aneurysm (n = 41), traumatic transection (n = 27), complicated acute type B dissection (n = 20), penetrating ulcer (n = 4), intramural hematoma (n = 3), penetrating injury (n = 3), and embolizing lesion (n = 2).Main Outcome MeasuresDemographics and 30-day and late outcomes were analyzed using multivariate analysis over a mean follow-up of 33.8 months.ResultsAmong the 100 patients, mean (SD) age was 58.5 (17.3) years (range, 18-87 years). Demographics and comorbid conditions were similar between the 2 groups, except more patients in the DTAR group had prior aortic surgery (P = .02) and were older (P = .01). Overall 30-day mortality was significantly better among the TEVAR group (8% vs 29%; P = .007). Incidence of postoperative myocardial infarction, acute renal failure, stroke, and paraplegia/paresis was similar between the 2 treatment groups (TEVAR, 5%, 12%, 8%, and 8% vs DTAR, 13%, 13%, 9%, and 13%, respectively). Major respiratory complications were lower in the TEVAR group (16% vs 48%; P < .05). Mean length of hospital stay was also shorter after TEVAR (13.5 vs 16.3 days; P = .30). Independent predictors of patient mortality included age (P = .004) and DTAR (P = .001).ConclusionPatients presenting with ACDTA are best treated with TEVAR whenever feasible.

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