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Results of thoracic endovascular grafting in different aortic segments
Germano Melissano1, Luca Bertoglio, Efrem Civilini
1Department of Vascular Surgery, Vita - Salute University, Scientific Institute H. San Raffaele, Milan, Italy. g.melissano@hsr.it
Insights
Thoracic endovascular grafting shows favorable results for aortic arch and descending thoracic aorta (DTA) pathologies. Hybrid procedures enable treatment of all aortic segments but reduce success rates, especially for thoracoabdominal aorta (TaA) cases.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Disease Management
Background:
- Thoracic endovascular aortic repair (TEVAR) has evolved for treating various aortic pathologies.
- Commercially available stent-grafts offer options for complex aortic repairs.
- Hybrid procedures combine endovascular and open surgical techniques.
Purpose of the Study:
- To compare outcomes of thoracic endovascular grafting across different aortic segments.
- To evaluate the efficacy of commercially available stent-grafts in TEVAR.
- To assess the impact of hybrid procedures on TEVAR success rates.
Main Methods:
- Retrospective analysis of 178 patients undergoing TEVAR between 1999 and 2006.
- Patients categorized into aortic arch, descending thoracic aorta (DTA), and thoracoabdominal aorta (TaA) groups.
- Inclusion of hybrid procedures for supra-aortic trunk revascularization, access, or associated abdominal aortic aneurysms.
Main Results:
- Overall technical success rate of 93.8% with 5.6% 30-day mortality.
- Descending thoracic aorta (DTA) group showed highest technical success (98.0%) and lowest mortality (2.0%).
- Aortic arch and thoracoabdominal aorta (TaA) groups had higher complication rates and lower initial/midterm success, particularly TaA (28.6% 30-day mortality).
Conclusions:
- Endovascular grafting is effective for DTA and aortic arch pathologies.
- Hybrid procedures facilitate treatment of all aortic segments but may decrease success rates.
- Stent-graft use for thoracoabdominal aorta (TaA) should be reserved for high-risk or compassionate cases.
Purpose:
To compare the results of thoracic endovascular grafting of different aortic segments performed with commercially available stent-grafts.
Methods:
Between January 1999 and October 2006, 178 patients (150 men; mean age 69.4+/-10.2 years) underwent endovascular grafting of the thoracic aorta (68 hybrid procedures) with commercially produced stent-grafts from 4 manufacturers. Patients were divided into 3 groups according to the aortic segment involved: 64 aortic arch cases (37 hybrids for supra-aortic trunks revascularization), 100 descending thoracic aorta (DTA) cases (17 hybrid: 12 for access and 5 for associated abdominal aortic aneurysm), and 14 thoracoabdominal aorta (TaA) patients excluded from conventional repair (14 hybrids for renal and splanchnic revascularization).
Results:
The technical success was 93.8% (167/178). Overall 30-day mortality was 5.6% (10/178). There were 10 (5.6%) type I endoleaks. Initial clinical success was 88.2% (157/178). At a mean follow-up of 29.3+/-21.2 months, the midterm clinical success was 89.9% (160/178). In the arch group, the technical success was 85.9% (55/64). Thirty-day mortality was 6.3% (4/64). There were 8 (12.5%) type I endoleaks. Initial and midterm clinical success rates were 79.7% (51/64) and 85.9% (55/64), respectively. In the 100-patient DTA group, the technical success was 98.0%. Thirty-day mortality was 2.0%. The type I endoleak rate was 2.0%. Clinical success was 96.0% initially and 95.0% at midterm. All 14 of the TaA cases were completed successfully, but 30-day mortality was 28.6% (4/14). There were no type I endoleaks. Clinical success rates initially and at midterm were both 71.4% (10/14).
Conclusion:
Over the last 6 years, synergy between endovascular and surgical procedures allowed treatment of all segments of the thoracic aorta. Overall perioperative and medium-term results were reasonably favorable; however, they were more satisfactory when the descending thoracic aorta alone was involved. Hybrid procedures allowed treatment of all aortic segments, but they decreased the success rates significantly. Endovascular grafting is currently our preferred method of treating pathologies involving the DTA and aortic arch, while our data suggest limiting the use of stent-grafts to high-risk patients or compassionate indications when the thoracoabdominal aorta is involved.
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