Endovascular stent graft repair of thoracic aortic aneurysms

Aneurysmal disease of the thoracic aorta continues to present vexing challenges to the aortic surgeon. Not only does the incidence of the disease seem to be increasing, but the older population also harbors more comorbidities. In an effort to reduce the perioperative mortality and morbidity, surgeons and interventional radiologists at Stanford University Medical Center devised a less invasive, endovascular stent-graft repair. This report details the results of the first 81 patients, and reviews some other pertinent developments. The stent-graft is composed of interlocked, self-expanding "Z" stents covered with a woven Dacron graft, which can then be introduced through a hollow 27F Teflon sheath under fluoroscopic guidance and deployed across the aneurysm. Aneurysms of the descending thoracic aorta are most easily treated, but distal arch pathology can occasionally be accommodated. A friction seal prevents movement of the stent, and complete exclusion of the aneurysm sac from the circulation is usually possible. Degenerative aneurysms accounted for the majority of the diseased aortas.

There were 7 (9% +/- 3%) deaths, 3 directly attributable to the stent-graft procedure, including two strokes presumably from atheroemboli from the aortic arch. Paraplegia occurred in three patients, but in only one with an uncomplicated stent-graft placement without protracted hypotension. Two nonfatal strokes also occurred. There has been only a single instance of documented late graft failure, which resulted in a fatal hemorrhage. Although the long-term durability of the stent-grafts in unknown at this early stage, we believe this technology to be a significantly less morbid treatment for aneurysmal disease of the descending thoracic aorta. Only long-term follow-up will further define its utility.