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Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts
M Grabenwöger1, D Hutschala, M P Ehrlich
1Department of Cardio-Thoracic Surgery, University of Vienna, Austria. martin.grabenwöger@univie.ac.at
Background:
This study was performed to evaluate the safety and feasibility of endovascular stent graft placement in the treatment of descending thoracic aortic aneurysms.
Methods:
Between November 1996 and February 1999, endovascular stent graft repair was used in 21 patients. There were 5 women and 16 men with a mean age of 67 years (range, 41 to 87 years). An atherosclerotic aneurysm with a diameter of more than 6 cm was the indication for intervention in 19 patients (90.5%). In 2 patients (9.5%), a localized aortic dissection with a diameter of more than 6 cm was treated. In 71.4% (15 of 21) of patients, multiple stents were necessary for aneurysm exclusion. To allow safe deployment of the stent graft, preliminary subclavian-carotid artery transposition was performed in 9 patients (42.9%). Vascular access was achieved through a small incision in the abdominal aorta (n = 6), an iliac artery (n = 8), or a femoral artery (n = 7). Talent and Prograft stent grafts were used.
Results:
Successful deployment of the endovascular stent grafts was achieved in all patients. Two patients died postoperatively (mortality rate, 9.5%), 1 of aneurysmal rupture and the other of impaired perfusion of the celiac axis. Repeat stenting was done in 3 patients because of intraoperative leakage.
Conclusions:
Endovascular stent graft repair is a promising and less invasive alternative to exclude the aneurysm from blood flow. This technique allows treatment of patients who are unsuitable for conventional surgical procedures. An exact definition of inclusion criteria and technical development of stent grafts should contribute to further improvements in clinical results.
Insights
Endovascular stent graft repair offers a less invasive option for descending thoracic aortic aneurysms. This technique shows promise for patients unsuitable for traditional surgery, with successful deployment in all cases.
Area of Science:
- Cardiovascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Treatment
Background:
- Descending thoracic aortic aneurysms pose significant risks.
- Conventional surgical repair is associated with high morbidity and mortality.
- Endovascular stent grafting presents a less invasive alternative.
Purpose of the Study:
- To evaluate the safety and feasibility of endovascular stent graft placement.
- To assess the efficacy of this technique in treating descending thoracic aortic aneurysms.
- To identify potential improvements for future clinical outcomes.
Main Methods:
- 21 patients underwent endovascular stent graft repair between 1996 and 1999.
- Indications included atherosclerotic aneurysms (90.5%) and aortic dissections (9.5%).
- Procedures involved subclavian-carotid artery transposition in 42.9% and various vascular access sites.
Main Results:
- Successful stent graft deployment was achieved in all patients.
- The postoperative mortality rate was 9.5% (2 of 21 patients).
- Repeat stenting was required in 3 patients due to intraoperative leakage.
Conclusions:
- Endovascular stent graft repair is a viable, less invasive treatment for thoracic aortic aneurysms.
- This method expands treatment options for patients ineligible for open surgery.
- Further refinement of inclusion criteria and stent graft technology can enhance results.