Thoracic stent grafting for acute aortic pathology

Area of Science:

• Cardiovascular Surgery
• Endovascular Interventions
• Thoracic Aortic Pathology

Background:

• Elective endovascular repair of the thoracic aorta reduces morbidity and mortality compared to open surgery.
• Limited studies exist on thoracic endovascular stent grafts for acute aortic conditions.
• This study details experience with stent grafting for acute thoracic aortic pathology.

Purpose of the Study:

• To describe the increasing experience with thoracic endovascular stent grafting for acute aortic pathology.
• To evaluate the feasibility and outcomes of this approach in critically ill patients.

Main Methods:

• 28 patients with acute thoracic aortic diseases underwent endovascular stent graft treatment since January 2002.
• Conditions included Stanford type B dissection, ruptured aneurysms, intramural hematoma, traumatic rupture, aortopulmonary fistula, and penetrating aortic ulcers.
• Talent stent grafts were used in 26 patients, Excluder in 2; 75% of pathologies were in the proximal descending thoracic aorta.

Main Results:

• Successful stent graft deployment was achieved in all patients.
• Intraoperative mortality was 3.6% (1 patient); hospital mortality was 21.4% (6 patients), primarily due to preoperative conditions.
• Neurologic symptoms occurred in 4 patients, mostly improving during hospitalization; 22 hospital survivors were alive at a mean follow-up of 11 months.

Conclusions:

• Thoracic stent grafting is a feasible option for acute aortic pathology, even in critically ill patients.
• Postoperative morbidity and mortality are mainly linked to the patients' preoperative clinical status.
• This technique serves as a valuable salvage strategy for acute thoracic aortic conditions.