Treatment of Thoracic Aortic Dissection With Stent-Grafts: Midterm Results
Yonsei University, Sŏul, Seoul, South Korea Journal of Endovascular Therapy
(Impact Factor: 3.35).
01/2003; 9(6):817-21. DOI: 10.1583/1545-1550(2002)009<0817:TOTADW>2.0.CO;2
To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta.
Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 +/- 13.7 years, range 32-82) with descending thoracic aortic dissection. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up.
Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the procedure. Over an average follow-up of 31.5 +/- 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 patients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved.
Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.
Available from: PubMed Central
- "The introduction of endovascular repair which was described as a less invasive method of treating descending thoracic aortic disease was a significant advance in the care of these high risk patients. Shim et al. (12) reported the feasibility and safety of stent-grafting type B dissections with a 93% technical success rate (13). White et al. recently reported acceptable 30-day and 1 year mortality and morbidity rates after emergency TEVAR for complicated type B aortic dissections (i.e. "
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ABSTRACT: This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease.
From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes.
The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65).
Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.
- ". Its application has also been extended to various thoracic aortic pathologies including aneurysm , trauma  and dissection . Its use in mycotic aneurysms is controversial because of the concern of stent-graft infection. "
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ABSTRACT: Salmonella mycotic thoracic aortic aneurysm is a rare but life-threatening condition. We report a 59-year-old man with two
Salmonella mycotic thoracic aortic aneurysms, presented with fever and chills associated with hoarseness due to left vocal
cord palsy (Cardiovocal syndrome). Successful endovascular repair was performed using two Talent thoracic stent-graft devices
deployed separately to cover the two mycotic aneurysms. Subsequent computed tomography at 12 months after the operation confirmed
exclusion of the two pseudoaneurysms with no endoleak. With potent antibiotics and careful surveillance program, endovascular
repair is a possible alternative to conventional open surgery in the management of mycotic thoracic aortic aneurysms, especially
in high-risk patients.
Available from: Germano Melissano
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ABSTRACT: New devices for endovascular treatment of thoracic aortic diseases were recently approved for clinical use by European authorities, obtaining the Conformité Européenne (CE) mark. In all patients who underwent endovascular treatment of a thoracic aortic disease in 2002, we used a new CE-marked device, the Endofit stent graft. The device is constituted of nitinol stents and polytetrafluoroethylene fabric, and has a simple design and delivery system.
During 2002, 11 patients (mean age, 75 years; range, 66-85 years) underwent treatment of atherosclerotic aneurysm (n = 9), chronic type B dissection (n = 1), and intramural hematoma (n = 1). Disease involved the descending thoracic aorta in 7 patients and the distal aortic arch in 4 patients.
In all cases the Endofit stent grafts were successfully deployed in the intended position. No postoperative paraplegia or paraparesis was recorded. There were two in-hospital deaths: 1 patient died in the operating room (postmortem examination showed a kinked graft); and the other patient died in the intensive care unit on postoperative day 30, after an intraoperative stroke. One surgical conversion was performed 2 weeks after the procedure, because of total collapse of the graft due to rupture of three stents. Other graft-related complications included type I endoleak (n = 2), type II endoleak (n = 1), and incomplete opening of the device (n = 1).
Endovascular treatment of thoracic disease with the Endofit graft in this small heterogeneous group of patients resulted in several complications, which may arise from both the delivery system and the graft itself. At present, other commercially available endografts may be safer for endovascular treatment of thoracic aortic diseases.
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