Aneurysms of the Thoraco-abdominal Aorta: A Comparison with Propensity Score between Endovascular Repair and Open Surgery

Objectives: The aim of this study was to evaluate the results of endovascular surgery (ES) with the use of fenestrated and branched stentgrafts and open surgery (OS) for the treatment of aneurysms of the thoraco-abdominal aorta (TAA) in a current series of the patients. Materials and Methods: All the patients treated for TAA repair in three centers between January 2007 and December 2014 were included in a prospective database. The patients were stratified according to treatment by ES or OS and the results were compared using the propensity score (1:1). The covariables were age, gender, extension of the aneurysm, hypertension, coronary disease, chronic lung disease, diabetes, and renal function. The principal criteria of evaluation were mortality and paraplegia. The secondary criteria included spinal cord ischemia (SCI), respiratory or renal impaired function and a composite of these complications or the death at 30 days. Survival and reinterventions were compared in the two groups. Results: Among 341 patients, 84 (25%) underwent ES and 257 OS (75%). After the correspondences of the propensity score (65 patients by group), no significant difference was observed for death rates at 30 days (7.7% in ES and 6.2% in OS; p ¼1) or for paraplegia (9.2% and 10.8%; p¼1). SCI, impaired renal and respiratory function were 12.3% and 20% (p¼0.34), 9.2% and 12.3% (p¼0.78), and 0% and 12.3% (p¼0.006), after ES and OS, respectively. The incidence of the composite criterion of evaluation was significantly lower in ES patients (18.5% in ES vs. 36.0% in OS, p¼0.03). According to the Kaplan Meier method, survival at 24 months was 82.8% for ES and 84.9% for OS with unchanged rates at 42 months (p¼0.9). When comparing ES and OS, the absence of reintervention rates were 91.0% vs. 89.7% at 24 months, and 80.0% vs. 79.9% at 42 months, respectively (p ¼ 0.3). Conclusion: The analysis of the propensity scores in patients who underwent a repair for TAA suggests an early benefit of ES compared to OS with regard to a composite criterion because of respiratory complications at 30 days. No significant difference was observed in the SCI and impaired renal function rates at 30 days, nor in the long-term survival and reintervention rates.