Endovascular Repair of Thoracic Aortic Aneurysms: A Paradigm Shift in Standard of Care

Abstract

The standard open surgical treatment of thoracic aortic aneurysms is associated with significant morbidity and mortality. Endovascular repair is less invasive and potentially less morbid for patients with multiple risk factors. The authors report their results in 9 consecutive high-risk patients treated with endovascular grafts from January 1998 through June 2000. There were 7 men and 2 women patients with an average age of 75 years. Mean aneurysm diameter was 7.1 cm. All aneurysms were repaired with Gianturco Z-stent polytetrafluoroethylene prostheses. There were no perioperative deaths. Mean length of stay was 6.3 days. Technical success was achieved in all 9 patients. Two patients had neurologic complications following repair (1 patient with transient lower extremity numbness related to spinal arthritis and 1 patient with bowel and bladder incontinence). Both patients were independent with ambulation. Mean follow-up was 15.8 months. There was no evidence of endoleak or stent migration during the follow-up period. These findings support endovascular treatment of high-risk patients with thoracic aneurysm.

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References

1. Pressler V , McNamara JJ : Thoracic aortic aneurysm. Natural history and treatment. J Thorac Cardiovasc Surg 79:489-498, 1980.

2. Moreno-Cabral CE , Miller DC , Mitchell RS , et al: Degenerative and atherosclerotic aneurysms of the thoracic aorta. J Thorac Cardiovasc Surg 88:1020-1032, 1984.

3. Dake MD , Miller DC , Semba CP , et al: Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 331:1729-1734, 1994.

4. Rousseau H , Soula P , Perreault P , et al: Delayed treatment of traumatic rupture of the thoracic aorta with endoluminal covered stent. Circulation 99:498-504, 1999.

5. Semba CP , Sakai T , Slonim SM , et al: Mycotic aneurysms of the thoracic aorta: Repair with use of endovascular stent-grafts. J Vasc Interv Radiol 9:33-40, 1998.

6. Semba CP , Kato N , Kee ST , et al: Acute rupture of the descending thoracic aorta: Repair with use of endovascular stent-grafts. J Vasc Interv Radiol 8:337-342, 1997.

7. Semba CP , Mitchell RS , Miller DC , et al: Thoracic aortic aneurysm repair with endovascular stentgrafts. Vasc Med 2:98-103, 1997.

8. Greenberg R , Resch T , Nyman U , et al: Endovascular repair of descending thoracic aortic aneurysms: An early experience with intermediate-term follow-up. J Vasc Surg 31:147-156, 2000.

9. Ehrlich M , Grabenwoeger M , Cartes-Zumelzu F , et al: Endovascular stent graft repair for aneurysms on the descending thoracic aorta. Ann Thorac Surg 66:19-25, 1998.

10.

10. DeBakey ME , McCollum CH , Graham JM : Surgical treatment of aneurysms of the descending thoracic aorta: Long-term results in 500 patients. J Cardiovasc Surg 19:571-576, 1978.

11.

11. Mitchell RS , Dake MD , Semba CP , et al: Endovascular Stent-graft repair of thoracic aortic aneurysms. J Thorac Cardiovasc Surg 111:1054-1062, 1996.