Comparing neurological complications between endovascular and open surgical repair of the descending thoracic aorta

Background: Diseases of the descending thoracic aorta (DTA) can require endovascular, open, or a hybrid repair. Endovascular repair involves the minimally invasive placement of a stent graft, whereas open repair requires a thoracotomy to replace tissue with a graft. This study aims to compare the neurological morbidity associated with endovascular vs open repair of the DTA, and specifically for unruptured DTA aneurysm and DTA dissection. Methods: We utilized TriNetX, a deidentified patient database to query adult patients with endovascular and open repair of DTA disease, unruptured aneurysm, and dissection. Propensity score matching was conducted for age, sex, and several comorbidities including tobacco use, diabetes mellitus, chronic kidney disease, hypertension, and connective tissue disorders. We studied ischemic stroke, intracranial hemorrhage, spinal cord ischemia, and mortality at 30 days and 1, 5, and 10 years postoperatively. χ² analyses and odds ratios were calculated for each cohort at each time point. Results: After propensity matching, we studied 3229 patients for repair for DTA disease, 116 for unruptured descending thoracic aortic aneurysm, and 126 for descending thoracic aortic dissection. We find that endovascular repair of the DTA is associated with a lower likelihood of stroke at all time points and spinal cord ischemia and mortality within 30 days of surgery. At 5 and 10 years, patients with open procedures have a lower likelihood of all-cause mortality. No significant difference in odds were observed for patients with aneurysms or dissections. Conclusions: Patients undergoing repair of the descending thoracic aorta should be monitored closely intraoperatively and postoperatively for neurological events to allow for early rescue maneuvers and interventions to reduce overall morbidity and complication rates.