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Endoluminal stent grafting of the descending thoracic aorta
Marco Totaro1, Giuseppe Mazzesi, Antonino G M Marullo
1Institute of Cardiac Surgery, La Sapienza University, Rome, Italy. marcototaro@virgilio.it
Insights
Endovascular stent grafting offers a less invasive option for descending thoracic aorta diseases. This study shows promising mid-term results with no mortality for aortic dissections and aneurysms treated with stent grafts.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Endovascular Interventions
Background:
- Descending thoracic aortic diseases present surgical challenges.
- Endovascular treatment is an increasingly favored, less invasive alternative to open surgery.
- This technique preserves tissue integrity and avoids major surgical trauma.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular stent grafting for descending thoracic aorta diseases.
- To assess outcomes for patients with descending thoracic aorta dissections and aneurysms treated with covered stents.
Main Methods:
- A total of 32 patients with descending thoracic aorta dissection (n=25) or aneurysms (n=7) underwent endovascular procedures using covered stents.
- Procedures were performed under general or spinal anesthesia, with no anesthesia-related complications reported.
- Uncomplicated Type B dissections were treated in the subacute phase (1 week to 1 month post-onset) after pharmacological treatment.
Main Results:
- Successful endovascular stent placement was achieved in all feasible cases for descending thoracic aorta disease.
- One major complication occurred: a retrograde ascending aorta dissection requiring emergency surgical repair.
- Mid-term follow-up demonstrated excellent outcomes, with zero mortality and no stent-related complications.
Conclusions:
- Stent grafting is emerging as a preferred alternative to conventional surgery for thoracic aorta aneurysms and dissections.
- Delaying endovascular treatment for uncomplicated dissections until the subacute phase may reduce risks.
- Endovascular stent grafting significantly decreases risks and mortality associated with these conditions.
Background:
The timing and optimal therapy for descending thoracic aortic diseases still remain a challenging problem for surgeons. Nowadays endovascular treatment is becoming more and more popular both for acute as well as chronic cases. This technique is more respectful of the tissue integrity and avoids major and demolitive surgery for the patient.
Methods:
In 1 year 32 patients presenting with descending thoracic aorta dissection (n = 25) or with descending thoracic aorta aneurysms (n = 7) were submitted to an endovascular procedure using covered stents. Ten of them were operated upon in general anesthesia whereas in 22 spinal anesthesia was administered. In neither group did anesthesia-related complications occur.
Results:
In all cases in which endovascular treatment was possible, an endovascular stent was used for the treatment of the descending thoracic aorta disease. Only 1 patient had a major complication, which was a retrograde dissection of the ascending aorta surgically treated in an emergency setting. Our policy is to treat uncomplicated type B dissections in the subacute phase after 1 week of antihypertensive pharmacological treatment, but within 1 month of onset. Our mid-term follow-up shows very good results with no mortality and no stent-related complications.
Conclusions:
Stent grafting is replacing conventional surgery for descending thoracic aorta aneurysms and dissections. Our results suggest that in case of dissections, endovascular treatment should be delayed until the subacute phase, in the absence of complications. The risks and mortality are decreased.