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Published on: August 1, 2025
Stent-graft placement in atherosclerotic descending thoracic aortic aneurysms: midterm results
Martin Czerny1, Manfred Cejna, Doris Hutschala
1Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria. bypass@eunet.at
Insights
Midterm durability of stent-graft repair for descending thoracic aortic aneurysms is promising, with a low rate of reinterventions needed for endoleaks. Close patient follow-up after aortic aneurysm repair is essential.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Medical Device Technology
Background:
- Atherosclerotic descending thoracic aortic aneurysms pose significant risks.
- Endovascular stent-graft repair offers a less invasive treatment option.
- Evaluating the midterm durability of this approach is crucial for clinical practice.
Purpose of the Study:
- To assess the midterm durability of stent-graft placement in atherosclerotic descending thoracic aortic aneurysms.
- To determine the rate of reinterventions required due to endoleaks.
- To analyze the safety and efficacy of this endovascular technique.
Main Methods:
- A cohort of 54 patients with atherosclerotic descending thoracic aortic aneurysms underwent stent-graft repair.
- Two commercial stent-graft types (Talent and Excluder) were utilized.
- Patients were followed for a mean of 38 months post-procedure.
Main Results:
- The primary technical success rate was 94.4% with a 3.7% in-hospital mortality.
- Endoleaks were observed in 5.6% early and 21.9% late, with 7.7% requiring reintervention.
- Three-year event-free survival was 63%, with no neurological complications.
Conclusions:
- Endovascular stent-graft placement demonstrates promising midterm durability for descending thoracic aortic aneurysms.
- The incidence of endoleaks necessitating reintervention is acceptably low.
- Early detection and management of endoleaks through close surveillance are vital for successful outcomes.
Purpose:
To determine midterm durability and need for reinterventions after stent-graft placement in atherosclerotic descending thoracic aortic aneurysms.
Methods:
Fifty-four patients (38 men; mean age 68 years, range 33-87) underwent stent-graft repair of chronic atherosclerotic aneurysms of the descending thoracic aorta between November 1996 and December 2002. Acute aortic syndromes (type B aortic dissections, perforating ulcers, and traumatic dissections) were excluded from analysis. Two types of commercially available stent-grafts were used (Talent and Excluder).
Results:
The primary technical success rate was 94.4%. In-hospital mortality was 3.7% (2/54). No adverse neurological events were encountered. Of 3 (5.6%) early type I endoleaks, 2 (3.7%) required reintervention; the other type I endoleak closed spontaneously. Mean follow-up was 38 months (range 1-72) in the 52 surviving patients. Four (7.7%) type I, 7 (13.5%) type II, and 4 (7.7%) type III endoleaks were seen. Three 3 patients had additional treatment for endoleaks (proximal stenting [type Ia], open thoracoabdominal repair [type Ib], and embolization [type II]). Two of the 3 reinterventions were performed in the first year of follow-up. One additional patient with a type Ia endoleak not suitable for reintervention is under close observation. There were no differences in the number of endoleaks between the 2 types of stent-grafts. Three-year event-free survival was 63%.
Conclusions:
Midterm durability of endovascular stent-graft placement in atherosclerotic descending aortic aneurysms seems promising, as the rate of endoleaks requiring reintervention is acceptably low. In our series, endoleak formation occurred during the first year after stent-graft placement, so close follow-up of patients after aortic aneurysm repair is crucial. Further studies are warranted to evaluate long-term durability of this new treatment modality.
