[Endovascular stent-graft repair for thoracic aortic aneurysm]

Endovascular stent-grafting holds great potential as a minimally invasive alternative to open surgery for thoracic aortic aneurysm. Although there have been several commercially available stent graft systems applied to abdominal aortic aneurysm in the United States, Gore TAG is the only device that is approved by Food and Drug Association (FDA) for thoracic aortic aneurysm repair. Experience of endovascular aneurysm repair by our homemade system and TAG device which is crafted particularly for the thoracic aorta is reported. TAG was successfully delivered to the target region in 137 patients (98%). The aneurysm was successfully excluded by our homemade system in 258 patients (94%). The mortality rates of TAG and our homemade device groups were 2.1 and 3.6% respectively. Postoperative stroke incidence was 1.8% and was more frequent in patients with stent-graft deployed in the region between the landing zone map of Z3 and Z4. The rate of paraplegia/paraparesis with delayed onset was 2.8% in TAG group, and was almost similar in the homemade group (2.6%). The event-free rate of patients treated with stent-graft was low as compared to that of open surgery in 1 and 3 year follow-up period. Endovascular stent-grafting is feasible as one treatment option for thoracic aortic aneurysm. Selection of proper indications, development of the better device and technical improvement are keys to successful stent-grafting.