Endovascular Aortic Repair in Patients With Marfan and Loeys-Dietz Syndrome

In this article the authors aimed to report the midterm outcomes after endovascular aortic repair in patients with Marfan or Loeys-Dietz syndrome. Patients were analyzed based on the timing of the procedure, whether it was an elective or emergency procedure, and the nature of the landing zone (safe vs. unsafe). A population of 419 patients with Marfan (n = 352) or Loeys-Dietz syndrome (n = 67) from two European centers was analyzed. Among them, 39 patients (9 percent) underwent endovascular aortic repair. Thoracic endovascular repair (TEVAR) was performed in 34 patients and abdominal endovascular aortic repair (EVAR) was performed in five patients. The indication for endovascular repair was aortic dissection in 13 (33 percent) patients, aortic aneurysm in 22 (57 percent) patients, and other indications in in 4 (10 percent) patients. There was no statistically significant difference in the rate of reinterventions between patients with unsafe landing zones and the patients with safe landing zones (P = 0.609), and no increased probability for reintervention after elective endovascular intervention compared to emergency procedures (P = 0.916). Hence, the authors concluded that endovascular aortic repair in patients with Marfan or Loeys-Dietz syndrome is feasible and safe in patients with a safe landing zone, and a viable option when employed by a multidisciplinary aortic team even if the landing zone is unsafe.