Early Outcomes of TEVAR: Spinal Cord Ischemia and Reintervention Rates in a Single-Center Study

Objective: Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for various thoracic aortic pathologies due to its technical advantages over open surgery. This single-center study aims to analyze early outcomes of TEVAR, specifically focusing on spinal cord ischemia (SCI) and reintervention rates, while examining their relationships with patient and procedural variables. Methods: Data from patients who underwent TEVAR between February 2012 and August 2023 were retrospectively collected. Patients were categorized by pathology type: thoracic aortic aneurysms (n=97, 66.4%), type B aortic dissections (n=28,19.2%), traumatic aortic injuries (n=12, 8.2%), and other pathologies (n=9, 6.2%).Primary outcomes were spinal cord ischemia and 1-year reinterventions rates. Secondary outcomes included stroke, upper extremity ischemia, and 30-day mortality. Statistical analysis included univariate and multivariate logistic regression, Kaplan-Meier survival analysis, and subgroup comparisons between elective and urgent cases. Results: In the dataset of 146 patients, 116 (79.45%) were male, with an average age of 63.23 ± 12.50. Elective procedures were performed in 121 patients (82.9%) versus 25 urgent cases (17.2%). Among the complications, postoperative stroke was observed in 20 patients (13.7%), and upper extremity ischemia, likely due to occlusion of the subclavian artery, was observed in 10 patients (6.84%). Spinal cord ischemia was observed in 11 patients (7.5%), while TEVAR-related reintervention was required in 38 patients (26%). No significant relationship was found between SCI and the variables (p-value > 0.05); however, reintervention was required in 38 patients (26.0%) and was significantly associated with diabetes mellitus (OR 3.2, 95% CI 1.3-7.8, p=0.01), smoking history (OR 2.1, 95% CI 1.0-4.4, p=0.05), and distal zone lesions (OR 2.4,95% CI 1.1-5.2, p=0.03). Overall 30-day mortality was 17.1%. Urgent cases had higher 30-day mortality (32.0% vs. 13.2%, p=0.02) and reintervention rates (40.0% vs. 23.1%, p=0.08). Conclusions: This study demonstrates that the risk of reintervention is increased in cases with a history of diabetes mellitus, smoking, and aortic pathologies located in the distal thoracic zone. Urgent procedures carry higher morbidity and mortality risks. However, the current findings need to be supported by larger randomized multicenter studies.