Faculty Collaboration Database

Endovascular stent-graft treatment for diseases of the descending thoracic aorta. Eur J Cardiothorac Surg 2001 Sep;20(3):514-9

Date

08/18/2001

Pubmed ID

11509272

DOI

10.1016/s1010-7940(01)00829-6

Scopus ID

2-s2.0-0034902620 (requires institutional sign-in at Scopus site)   61 Citations

Abstract

OBJECTIVE: Assessment of endovascular stent-graft treatment for diseases of the descending thoracic aorta as a valid and effective alternative to surgery.

METHODS: From March 1999 to August 2000, a total of 16 patients underwent deployment of endovascular stent-grafts in the descending thoracic aorta. Patients were divided into three groups according to the type of lesion. Group A (n=8) included five patients with atherosclerotic aneurysm and three with chronic post-traumatic pseudoaneurysm. Patients with acute post-traumatic pseudoaneurysm (n=3) and type B aortic dissection (n=5) were included in Groups B and C, respectively. All patients underwent 5-mm chest spiral angio-computerized tomography (CT) scan and angiography as preoperative assessment. The deployed stent-graft systems were Talent-Medtronic and Excluder-Gore.

RESULTS: A total of 20 stent-grafts were placed. Two patients required deployment of two grafts, while three grafts were juxtaposed in a third patient in order to treat larger lesions. There was no mortality related to the procedure, although one patient (6.2%) died because of multiorgan failure 24h post-operatively. The placement of the graft was successful in all cases except one affected with type B dissection and characterized by a very large intimal flap, which was eventually fenestrated by graft guidewire. Therefore, an optimal sealing of the grafts was achieved in 15 patients. However, in one patient the descending aorta had to be surgically replaced because of the calcified pseudoaneurysm still compressing the trachea and left bronchus. Two patients required a left carotid-subclavian by-pass in order to achieve a sufficient neck for the proximal placement of the graft. No spinal cord injuries were observed. At the follow-up, performed with chest spiral angio-CT scan within 72 h and scheduled at 6 and 12 months and once a year, no stent-graft related complications have been detected.

CONCLUSIONS: Endoluminal stent-graft treatment may represent a valid option in well-selected cases of descending thoracic aorta diseases. A longer follow-up in a larger series of patients is desirable to confirm these initial positive results.

Author List

Bortone AS, Schena S, Mannatrizio G, Paradiso V, Ferlan G, Dialetto G, Cotrufo M, de Luca Tupputi Schinosa L

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Aged
Aneurysm, False
Aorta, Thoracic
Aortic Aneurysm, Thoracic
Blood Vessel Prosthesis Implantation
Female
Humans
Male
Middle Aged
Postoperative Complications
Reoperation
Stents
Tomography, X-Ray Computed