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Stenting of the descending thoracic aorta: a six-year single-center experience
Miltiadis I Matsagkas1, Ioanna E Kirou, George Kouvelos
1Department of Surgery, Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina University Campus, S Niarchos Avenue, 45110 Ioannina, Greece. mimats@cc.uoi.gr
Insights
Endovascular repair of thoracic aortic pathologies is a safe and effective method, showing good early and mid-term results. This stenting technique offers a promising solution for patients with these serious conditions.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Descending thoracic aortic pathologies, including aneurysms and acute syndromes, carry significant morbidity and mortality.
- Traditional open surgical repair is associated with high risks, particularly in frail patients.
- Endovascular repair offers a less invasive alternative for treating these complex conditions.
Purpose of the Study:
- To evaluate the six-year outcomes of endovascular repair for descending thoracic aortic pathologies.
- To report early perioperative results and mid-term follow-up data.
- To assess the safety and efficacy of thoracic endovascular aortic repair (TEVAR).
Main Methods:
- Retrospective review of 55 consecutive patients undergoing TEVAR over a six-year period.
- Analysis of patient demographics, pathology types (aneurysms, acute syndromes, traumatic ruptures), and treatment indications (elective vs. emergency).
- Inclusion of data on adjunctive procedures like left subclavian artery overstenting and simultaneous abdominal aortic lesion treatment.
Main Results:
- Primary technical success rate of 92.7%.
- Perioperative complications occurred in 12.7% of patients, with a 3.6% incidence of neurological complications.
- Combined 30-day and in-hospital mortality was 9.1%, primarily in emergency cases. Four-year cumulative survival was 72.6%.
Conclusions:
- Endovascular repair of descending thoracic aortic pathologies is a well-established method with favorable early and mid-term outcomes.
- TEVAR demonstrates acceptable morbidity and mortality rates, making it a viable option for a broad patient population.
- Stenting of the thoracic aorta presents a potentially superior solution for managing devastating aortic diseases.
Objectives:
The aim of this study was to review the six-year results of the endovascular repair of descending thoracic aortic pathologies, reporting the early perioperative outcomes as well as the mid-term follow-up of the treated patients.
Methods:
Fifty-five consecutive patients who underwent endovascular repair for thoracic aortic pathology (32 aneurysms, 17 acute thoracic aortic syndromes, and six traumatic aortic ruptures) during a six-year period were retrospectively reviewed. From these patients, 30 (54.5%) were treated electively and 25 (45.5%) on an emergency basis. In eight cases (14.5%) there was a need for left subclavian artery orifice overstenting. In seven patients (12.7%) an abdominal aortic lesion was simultaneously treated, while three more patients (5.5%) had previously had their abdominal aortic aneurysm repaired.
Results:
The primary technical success was 92.7%. Seven patients (12.7%) underwent some operation related complication, while postoperative complications occurred in five patients (9.1%), namely four myocardial infarctions, one acute respiratory distress syndrome and two delayed parapareses resulting in an overall incidence of neurological complications of 3.6%. The combined 30-day and in-hospital mortality was 9.1%, exclusively related to patients treated emergently (P = 0.01). In a mean follow-up period of 34 months there were six deaths, and the overall cumulative survival at four years was estimated at 72.6%. Only one type II endoleak was observed one month after the procedure and it spontaneously disappeared 18 months later.
Conclusions:
The endovascular repair of descending thoracic aortic pathologies seems to be a well-established method, with favorable morbidity and mortality rates, at least for 30 days and in the mid-term. Taking into account the potential of a wide application of the endovascular technique in many vascular centers, stenting of the thoracic aorta might offer an overall better solution for patients suffering from these devastating pathologies.
