Fink, Jacob

Misselbeck, Tim S, MD

Wu, James K., MD

Zaki, Youssef

English

Misselbeck, Timothy S

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster Presentation10-year outcome of the Thoracic EndovascularAortic Repair (TEVAR) Procedure (Poster)Jacob FinkYoussef ZakiTim S. Misselbeck MDLehigh Valley Health Network, Timothy_S.Misselbeck@lvhn.orgJames K. Wu MDLehigh Valley Health Network, james.wu@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersPart of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtFink, J., Zaki, Y., Misselbeck, T., & Wu, J. (2016, July, 29) 10-year outcome of the Thoracic Endovascular Aortic Repair (TEVAR)Procedure. Poster presented at: LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.Fink, J., Zaki, Y., Misselbeck, T., & Wu, J. (2016, Oct, 29) 10-year outcome of the Thoracic Endovascular Aortic Repair (TEVAR)Procedure. Poster presented at: The 54th Annual Meeting of the Eastern Cardithoracic Surgical Society, St. Pete Beach, Florida.© 2016 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, Pennsylvania10-year outcome of the Thoracic Endovascular Aortic Repair (TEVAR) Procedure • Purpose: The goal of the study was to assess the positive and negative outcomes of the TEVAR procedure in hopes of identifying recurrent issues. • TEVAR has been FDA approved and implemented at Lehigh Valley Health Network (LVHN) since 2006.• TEVAR is used to treat aneurysms and dissections in the descending aorta and/or the aortic arch1. The Cardiothoracic surgeon accesses the aorta via the femoral artery. This is referred to as the Transfemoral (TF) approach and is the preferred method, although other methods of access are sometimes implemented. Several catheters are guided through the arteries to the aortic aneurysm/dissection. The catheters and stent are monitored using X-rays and ultrasounds. Once the stent is positioned properly, it is deployed (expanded) to fit the aorta and act as a new vessel through which blood can flow2. The aneurysm will eventually shrink in the most successful cases.Number of Patients (n) N = 76Age (Years), Range Mean Age = 83, Range = (18 – 88) Sex (Male or Female) Male = 46 Female = 30• This was a retrospective study that included 80 procedures performed on 76 patients at LVHN. The interval of study was from April 2006 to March 2016. • Patients were followed-up with post-operatively in the Cardiothoracic office. CT scans were performed at the time of each follow-up in order to check the status of the graft implant. • Data collection for this study consisted of reviewing the CT scan report at each follow-up and recording any complications with the graft or lack thereof. – Complications include leakage or migration of the graft implant3DEMOGRAPHICS OF TEVAR PATIENTSTable 2: Comorbidities• Hypertension – 80.26% (61/76)• Obesity – 17.11% (13/76)• Diabetes – 14.47% (11/76)• Kidney Disease – (acute  9.21%), (chronic  15.79%), (kidney failure  2.63%)• Smoking history – 61.84% (47/76)• Readmission within 90 days – 36.84% (28/76)• Aneurysm shrinkage – 25% (13/76)Jacob Fink, Youssef Zaki, Dr. Timothy Misselbeck M.D. and Dr. James Wu M.D. Department of Cardiothoracic SurgeryOVERVIEWMETHODS & DEMOGRAPHICSOUTCOMES RESULTSCONCLUSIONSTable 3: Patient status at time of follow-upWhat was the patient's status at the time of follow-up Survival(Did the patient survive?)FrequencyPercentDead Survival TotalDid Not Experience TEVAR Complication by the End of Follow-up 1722.3729.3168.004153.9570.6980.395876.32Experienced TEVAR Complication 810.5344.4432.001013.1655.5619.611823.68Total 2532.895167.1176100.00• 51 of the patients survived and 25 of them died• A total of 2 patients (8%) experienced TEVAR related deaths . One patient died during surgery while another patient died post-operatively due to a faulty graft and subsequent aneurysm. • Of the 76 patients 58 (76.32%) of them did not experience a complication at time of follow-up. • A total of 13 patients, around 25%, did report a shrinkage of their aneurysm at time of follow-up.  At time of follow-up 39 (75%) did not report a shrinkage. Also, 24 of the patients had a unknown size of their aneurysm post-operatively. • In the Kaplan-Meier curve as the years increase the survival probability decreases. So, at 5 years post-operatively the median survival is 50%.• Of the 18 (23.68) patients who did experience a complication 10 (13.16%) of them survived and 8 (10.53%)of them died. • 1 patient out of the 76 patients experienced right hemiplegia and subsequent death 5 months after the procedure, and 1 patient experienced weakness in the lower body TEVAR is well tolerated in a patient population with high co-morbid conditions. Ten out of eighteen of the patients who did experience a complication during follow-up experienced it within two years post-operatively of the procedure. LVHN or the manufacturers should look into a better implantation method or device material  that better suits the needs of the patient. The data shows that the patients who did not experience complications had a higher chance of survival. Patients and LVHN should minimize risk factors that contribute to post-operative  problems. (Obesity, Smoking, etc.). Also, patients should make sure to follow-up with their physician well after the procedure has been completed.References1.Qu, L., & Raithel, D. (2009). Techniques for precise thoracic endograftplacement. Journal of vascular surgery, 49(4), 1069-1072.2. Xu, S. D., Huang, F. J., Yang, J. F., Li, Z. Z., Yang, S., Du, J. H., & Zhang, Z. G. (2010). Early and midterm results of thoracic endovascular aortic repair of chronic type B aortic dissection. The Journal of thoracic and cardiovascular surgery, 139(6), 1548-1553.3. Morales, J. P., Greenberg, R. K., Lu, Q., Cury, M., Hernandez, A. V., Mohabbat, W., ... & Schoenhagen, P. (2008). Endoleaks following endovascular repair of thoracic aortic aneurysm: etiology and outcomes. Journal of Endovascular Therapy, 15(6), 631-638.• Kaplan Meier curve representing if a patient has a TEVAR complication, there survival probability • Table 3: representing patients status at time of follow-up • Table 2: representing the variables analyzed in this study and their results Table 4: Neurological Complications• Hemiparesis – 1.40%  (1/76)• Weakness of the lower extremities – 1.40% (1/76)• Table 4: Patients experiencing neurological complications post-operatively 

10-year outcome of the Thoracic Endovascular Aortic Repair (TEVAR) Procedure (Poster)

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10-year outcome of the Thoracic Endovascular Aortic Repair (TEVAR) Procedure (Poster)

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