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Midterm results of endoluminal stent grafting of the thoracic aorta
Laurence Destrieux-Garnier1, Stéphan Haulon, Serge Willoteaux
1Department of Vascular Surgery, Hôpital Cardiologique, CHRU, Lille, France.
Insights
Thoracic endovascular aortic repair (TEVAR) offers an alternative to open surgery for complex aortic lesions. This study shows successful implantation with manageable morbidity and mortality in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Endovascular Interventions
- Thoracic Aorta Diseases
Background:
- Thoracic aortic lesions require effective treatment options.
- Open surgical repair carries significant risks, especially in comorbid patients.
- Endovascular approaches are emerging as alternatives.
Purpose of the Study:
- To evaluate the outcomes of thoracic endovascular aortic repair (TEVAR) using endoluminal grafts.
- To assess the safety and efficacy of TEVAR in patients with various thoracic aortic pathologies.
Main Methods:
- Prospective study of 32 patients undergoing TEVAR between December 1999 and November 2001.
- Preoperative imaging included CT, angiography, or MRI.
- Post-procedure evaluation involved CT and chest radiography at discharge and follow-up (1, 6, 12 months).
Main Results:
- Successful graft implantation in all patients; no conversions to open surgery.
- 9% early mortality (neurologic event, myocardial infarction, multiorgan failure).
- Aortic diameter reduction or stability observed in 81% of patients; 19% showed increase, primarily in dissection cases.
Conclusions:
- TEVAR is a viable alternative to open surgery for thoracic aortic lesions, particularly in high-risk patients.
- Managed morbidity and mortality rates are associated with the patients' preoperative conditions.
- TEVAR demonstrated successful outcomes with potential for aortic remodeling.
Abstract:
The purpose of this study was to evaluate the overall outcome of repair of thoracic aortic lesions with endoluminal grafts. Patients were studied prospectively following the implantation of a thoracic endovascular device. Preoperative imaging was performed by helical computed tomography (CT), angiography, transesophageal ultrasonography, or magnetic resonance imaging. Procedures were performed in an endovascular surgical suite under general anesthesia. All patients were evaluated with CT and chest radiography at discharge and at 1, 6, and 12 months. From December 1999 to November 2001, thirty-two patients were enrolled in the study (mean age 62 years; 20 male and 12 female patients). Seventeen patients had dissections, five patients had ruptured aortic ulcer, five patients had traumatic ruptures, three patients had atherosclerotic aneurysms, and two patients had pseudoaneurysms. An American Society of Anesthesiology score of III or IV was evaluated in 22 (69%) patients. The procedure was performed under emergency conditions in 11 cases. All prostheses were implanted successfully. There were no conversions. Three patients (9%) presented with a neurologic event following the implantation procedure, which was lethal in one case (hemorrhagic stroke). Two other patients died during early follow-up of myocardial infarction and multiorgan failure. The early death rate was 9%. The mean follow-up was 13.5 months. During follow-up, the maximal diameter of the aorta shrunk (> or = 5 mm) in 9 (28%) patients, remained stable in 17 (53%) patients, and increased (> or = 5 mm) in 6 (19%) patients. All patients presenting with an increased diameter were initially treated for dissections. A type 1 endoleak was diagnosed on the discharge CT scan in one patient. It sealed spontaneously thereafter. A type 3 endoleak was diagnosed 3 months after the procedure in one patient. A complementary stent graft was implanted in two patients presenting with a dissection with persistent patent false lumen and aortic enlargement. Three patients died during follow-up (two aneurysm-related and one aneurysm-unrelated death). The morbidity and mortality rates reported in our series related to the preoperative morbid conditions of the patients treated. Thoracic aorta endografting is an alternative to open surgery in this subset of patients.
