Endovascular stent grafting for acute thoracic aortic pathology

Endovascular repair of the thoracic aorta has shown reduced morbidity and mortality compared with open surgery. We describe our experience with endovascular stent grafting in the treatment of acute thoracic aortic pathology.

From October 2003 to January 2008, 25 patients underwent endovascular stent graft repair of the thoracic aorta. The underlying pathology was a complicated Stanford type B dissection (n = 13), a symptomatic or ruptured thoracic aorta aneurysm (n = 6), a symptomatic penetrating atherosclerotic ulcer (n = 5), or a traumatic aortic injury (n = 1). There were 21 males and four female patients with a mean age of 61.3 years (30-91 years). Routine surveillance included clinical evaluation and contrast-enhanced spiral computed tomography scans before discharge and at 3, 6, and 12 months after the procedure and yearly thereafter.

Stent graft placement was technically successful in all patients. There was no intraoperative mortality. Hospital mortality was of two patients (8%). Paraparesis occurred in one patient (4%). Average intensive care unit and hospital stay was 1 and 10 days, respectively. The mean follow-up was 30 months (range, 7-53). Late mortality was in one patient (4%), due to a type A dissection. During the follow-up, four patients (16%) required a second procedure for type I endoleak.

Mortality and morbidity in our small series were low. Close follow-up is mandatory and long-term results have to be awaited.