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Endoluminal stent grafting of the thoracic aorta: initial experience with the Gore Excluder
Charles S Thompson1, Virginia D Gaxotte, Julio A Rodriguez
1Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute and Hospital, 2632 N 20th Street, Phoenix, AZ 85006, USA.
Insights
Endoluminal graft repair using the Gore Excluder device offers a safe and effective alternative for various thoracic aorta pathologies. This minimally invasive approach shows promising results compared to traditional open repair methods.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Thoracic Aorta Pathologies
Background:
- Open surgical repair of thoracic aorta pathologies carries significant risks.
- Endovascular stent-graft repair presents a less invasive alternative for selected patients.
- The Gore Excluder device is an investigational tool for thoracic endoluminal grafting.
Purpose of the Study:
- To evaluate the safety and efficacy of endoluminal graft repair for diverse thoracic aorta conditions.
- To assess the outcomes in patients eligible for open repair and those with high surgical risk.
- To describe the initial experience with the Gore Excluder device in thoracic endovascular procedures.
Main Methods:
- A cohort of 46 patients (mean age 70) underwent thoracic endovascular stent-graft repair with the Gore Excluder from Feb 2000 to Feb 2001.
- Patient conditions included atherosclerotic aneurysms (50%), dissections (30%), fistulas (7%), pseudoaneurysms (7%), traumatic ruptures (4%), and aortic ulcers (2%).
- Follow-up involved chest CT scans at 1, 3, 6, and 12 months, with a mean follow-up of 8.5 months.
Main Results:
- All procedures were technically successful with no conversions to open surgery.
- The overall morbidity rate was 23%, with two patients (4%) experiencing endoleaks requiring reintervention.
- Two patients (4%) died postoperatively; no cases of paraplegia were reported. Mean aneurysm sac reduction was observed in treated aneurysms.
Conclusions:
- Thoracic endoluminal grafting with the Gore Excluder is a safe and feasible alternative to open repair.
- The endovascular approach demonstrates favorable early results for thoracic aorta pathologies.
- This technique offers a promising alternative to conventional resection and graft replacement.
Purpose:
The purpose of this study was to describe our experience with endoluminal graft repair of a variety of thoracic aorta pathologies with a commercially developed device currently under investigation. Our patient population included patients eligible for open surgical repair and those with prohibitive surgical risk.
Methods:
From February 2000 to February 2001, endovascular stent-graft repair of the thoracic aorta was performed in 46 patients (mean age, 70 years; 29 male and 17 female patients) with the Gore Excluder. Twenty-three patients (50%) had atherosclerotic aneurysms, 14 patients (30%) had dissections, three patients (7%) had aortobronchial fistulas, three patients (7%) had pseudoaneurysms, two patients (4%) had traumatic ruptures, and one patient (2%) had a ruptured aortic ulcer. Patient characteristics, procedural variables, outcome, and complications were recorded. All patients were followed with chest computed tomographic scans at 1, 3, 6, and 12 months. Follow-up period ranged from 1 month to 15 months, with a mean of 8.5 months.
Results:
All the procedures were technically successful. There were no conversions. Average duration of the procedure was 120 minutes. Average length of stay was 6 days, but most patients (64%) left the hospital within 4 days after endoluminal grafting. The overall morbidity rate was 23%. Two patients (4%) had endoleaks that necessitated a second procedure for successful repair. Two patients (4%) died in the immediate postoperative period. There were no cases of paraplegia. At follow-up examination, one patient had an endoleak found the day after the procedure and another patient had an endoleak 6 months after the procedure. Both cases were treated successfully with additional stent-grafts. There were no cases of migration. One patient died of a myocardial infarction 6 months after graft placement. In patients treated for aneurysm (n = 23), the aneurysm diameter ranged from 5.0 to 9.5 cm (mean, 6.8 cm). Residual sac measurements were obtained at 1, 6, and 12 months, with mean sac reductions of 0.59 cm, 0.77 cm, and 0.85 cm, respectively. In three cases, the sac remained unchanged, without evidence of endoleak.
Conclusion:
Thoracic endoluminal grafting with the Gore Excluder is a safe and feasible alternative to open graft repair and can be performed successfully with good results. Early data suggest an endoluminal approach to these disease entities may be favorable over classical resection and graft replacement.