Endovascular treatment of thoracic aortic disease: four years of experience
Alessandro S Bortone1, Emanuela De Cillis, Donato D'Agostino
1Dipartimento Emergenza e Trapianti d'Organo, Sezione di Cardiochirurgia, Piazza Giulio Cesare 11 70124 Bari, Italy. abortone@cardiochir.uniba.it
Insights
Stent graft treatment for descending thoracic aorta diseases shows promising mid-term efficacy and low mortality. This endovascular approach is a viable option, even for acute conditions, with ongoing long-term follow-up.
Area of Science:
- Cardiovascular Surgery
- Endovascular Interventions
- Thoracic Aortic Disease
Background:
- Descending thoracic aorta diseases pose significant clinical challenges.
- Stent graft treatment offers a minimally invasive therapeutic option.
- Evaluating the efficacy and outcomes of stent graft interventions is crucial.
Purpose of the Study:
- To investigate the efficacy and middle-term results of stent graft treatment for descending thoracic aorta diseases.
- To assess the outcomes in patients with aneurysms, post-traumatic lesions, and complicated type B dissections.
- To compare outcomes with medical management for specific chronic dissection cases.
Main Methods:
- Retrospective study of 132 patients (March 1999 - October 2003).
- Patients categorized into aneurysms, post-traumatic lesions, complicated type B dissections, and medical management groups.
- Preoperative assessment included computed tomography (CT) scan and angiography.
- Follow-up involved serial chest CT scans for 100% completeness.
Main Results:
- Optimal stent graft deployment achieved in 96.4% of treated patients.
- Low operative mortality of 3.9% (4 hospital deaths).
- No spinal cord injuries observed; low incidence of stent graft complications.
- Medical management group showed a significantly higher mortality of 40.9%.
Conclusions:
- Endovascular stent graft treatment is a valid option for thoracic aortic diseases, including acute cases.
- The treatment demonstrates proven efficacy in the middle-term.
- Further long-term follow-up is necessary to fully ascertain durability and late outcomes.
Background:
The aim of this retrospective study is to investigate efficacy and middle-term results of the stent graft treatment for diseases of descending thoracic aorta.
Methods And Results:
From March 1999 to October 2003, 132 patients (113 male and 19 female, mean age 62+/-14 years) were enrolled. They were divided into 4 groups: aneurysms (43, group A), post-traumatic lesions (24, group B), and complicated type B dissections (43, group C). Twenty-two further patients, with chronic type B dissection and not suitable for endovascular or surgical or hybrid techniques because of multiple entry tears without difference between the true and false lumen and poor clinical conditions, were obliged to receive medical management only (group D). All patients underwent computed tomography (CT) scan and angiography as preoperative assessment. An optimal deployment with exclusion of the aneurysm and/or closure of the entry tear in dissection was achieved in 96.4% (106/110) of the patients that were discharged in good conditions within 6 days. No spinal cord injuries were observed. The follow-up (average 20.82+/-10.01 months, range 1 to 55 months), performed with serial chest CT scans, was 100% complete. No stent graft-related complications were detected, although only in 1 case, an asymptomatic rupture of the Excluder connecting bar was found with a perforation of the fabric and an intra-aortic exposition of the bar itself. In 2 patients with chronic dissection an asymptomatic type II endoleak was detected. A total of 4 hospital deaths resulted in an overall operative mortality of 3.9%. Seven patients (6.3%) died during the follow-up 5 of them for other diseases (4.5%). However, a 40.9% mortality was observed within the obliged medical treatment group.
Conclusions:
Endovascular treatment of thoracic aortic diseases, even in the acute phase, may represent a valid option with a low mortality rate. Moreover, the efficacy is proved in the middle-term whereas the long-term follow-up is still pending.
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