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Endovascular stent-grafting for diseases of the descending thoracic aorta
1Division of Angiology, Clinic for Cardiovascular Surgery, University Hospital Berne, CH-3010 Berne, Switzerland.
Insights
Endoluminal stent-grafting offers a less invasive option for thoracic aorta conditions. This technique demonstrated low mortality and morbidity in a small patient series, highlighting its potential as an alternative to open repair.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thoracic Aortic Disease Management
Background:
- Endoluminal stent-grafts are an emerging, less invasive alternative to open surgery for descending thoracic aortic pathology.
- Conventional open repair of thoracic aorta conditions carries significant risks.
Purpose of the Study:
- To describe the experience with endovascular stent-grafting in treating thoracic aorta pathology.
- To evaluate the safety and efficacy of endoluminal stent-grafting for descending thoracic aorta diseases.
Main Methods:
- Seventeen patients underwent treatment with 23 endovascular stent-grafts.
- Pathologies included atherosclerotic aneurysms, type B dissections, intramural hematomas, false aneurysms, Marfan's syndrome, and traumatic aortic rupture.
Main Results:
- Twenty-three stent-grafts were implanted; one patient required conversion to open repair.
- Six endoleaks (EL) were identified postoperatively (four type I, one type II, one type IV).
- One patient died, and one developed paresis; morbidity and mortality were low in this series.
Conclusions:
- Endoluminal stent-grafting is a viable alternative to open repair for selected descending thoracic aorta diseases.
- Continuous patient follow-up is essential after endovascular repair.
- This technique offers a less invasive approach with promising outcomes.
Principles:
Endoluminal stent-grafts are emerging as a less invasive alternative to conventional open surgery in the management of descending thoracic aortic dissections and aneurysms. We describe our experience with endovascular stent-grafting in the treatment of thoracic aorta pathology.
Methods:
17 Patients were treated with 23 endovascular stents. The underlying pathology was an atherosclerotic aneurysm verum (n = 5), a type B dissection with contained rupture (n = 3), an intramural haematoma with contained rupture (n = 1) and a false aneurysm of unknown origin (n = 1). One patient had Marfan's syndrome and six patients had a traumatic rupture of the descending aorta.
Results:
Overall 23 stent-grafts were implanted. In one patient, conversion to an open graft replacement of the descending aorta was necessary. One patient died. In four patients (23.5%) a left carotid-subclavia bypass or transposition was performed to achieve a sufficient neck for the proximal stent-graft landing zone. The postoperative control-CT scans revealed a total of six endoleaks (EL) (four type I, one type II and one type IV). Two patients needed a graft extension in a second operation (4 days and 18 month after the first operation), two EL (one type I and one type II) disappeared after 9 and 18 months, respectively and two EL are still under observation. One patient developed a paresis after conversion to open graft replacement.
Conclusions:
A variety of diseases of the descending aorta can be treated by endoluminal stent-grafting, which seems to be a valid alternative to open repair in well selected cases. Mortality and morbidity in our small series were low. Continuous follow-up is mandatory.
