# Descending Thoracic Aortic Diameter Is a Predictor of Poor Outcome After Endovascular Aortic Repair

## TL;DR

Larger descending thoracic aortic diameter before surgery is linked to worse outcomes after aortic repair.

## Contribution

This study identifies descending thoracic aortic diameter as a predictor of poor outcomes after TEVAR in large aneurysms.

## Key findings

- Larger aneurysms (≥7 cm) had higher risks of mortality and reintervention after TEVAR.
- Patients with aortic diameter ≤7 cm showed more favorable long-term outcomes.
- Aortic diameter was independently associated with complications like infection and endoleaks.

## Abstract

To evaluate the results of thoracic endovascular aortic repair (TEVAR) in large (diameter ≥7 cm) aneurysms of the descending thoracic aorta.

This cohort has been extrapolated from the prospective, observational (on-label and off-label), worldwide multicentre Global Registry for Endovascular Aortic Treatment (GREAT) (NCT01658787). Patients were divided into 2 groups based on the baseline aortic diameter: standard aneurysms (<7 cm) and larger aneurysms (≥7 cm). Primary outcomes were overall survival and freedom from TEVAR-related reintervention. Secondary outcomes were freedom from aortic-related mortality (ARM), as well as from type 1 endoleaks, and cumulative risk of TEVAR-related infection and/or aorto-bronchial/oesophageal fistulization.

We analysed 613 (80.4%) patients with standard aneurysms and 149 (19.6%) with larger aneurysms. Demographic data and comorbidities were not different between the groups. At the 4- to 6-year window, 496 (65.1%) patients remained under follow-up (standard, n = 409 [66.7%] vs large, n = 87 [58.4%]; odds ratio [OR]: 1.4, P = .056). Large aneurysm diameter was independently associated with higher hazards for all-cause mortality (hazard ratio [HR]: 1.6, 95% CI, 1.19-2.20; P < .001), TEVAR-related reintervention (HR: 2.4, 95% CI, 1.52-3.65; P < .001), risk of ARM (HR: 2.2, 95% CI, 1.03-4.75; P = .026), cumulative risk of TEVAR-related infection/fistulization, and type 1 endoleaks (HR: 3.3, 95% CI, 1.89-5.65; P < .001).

Preoperative descending thoracic aortic diameter seems to be an important determinant of outcomes after TEVAR, where patients presenting with aortic diameter ≤ 7 cm showed more favourable long-term outcomes.

Although studies have shown that maximum diameter does not fully predict aneurysm-related complications, currently it remains the most commonly used criterion determining the indication for intervention in aortic aneurysms.