Acute rupture of the descending thoracic aorta: repair with use of endovascular stent-grafts.
OBJECTIVE
To describe the use of endovascular stent-grafts to treat acute ruptures of the descending thoracic aorta as an alternative to surgery in high-risk patients.


METHODS
From July 1992 to August 1996, 95 patients underwent stent-grafting of the descending thoracic aorta for a variety of lesions. Of these, 11 patients with acute (< or = 7 days) rupture from aneurysms (n = 8) or trauma (n = 3) underwent repair with use of endovascular stent-grafts. Rupture was confirmed with preoperative imaging studies and occurred in the mediastinum (n = 9), the pleural space (n = 1), or the lung (n = 1). All patients were considered high surgical risk due to generalized cardiopulmonary disease and/or previous thoracotomies. Stent-grafts were constructed from Z stents covered with polyester fabric and delivered through a catheter under fluoroscopic control from a remote access site.


RESULTS
Stent-graft deployment was successful in all patients. There were no complications of perigraft leak, stent migration, paraplegia, or intraoperative death. Two patients died in the follow-up period: one of ventricular perforation during unrelated thoracic surgery for tumor resection (day 1) and one of cardiac arrest (day 28). All others are alive (mean follow-up, 15.1 months).


CONCLUSIONS
For acute rupture of the thoracic aorta, endovascular stent-graft repair is technically feasible and may be a therapeutic alternative to a surgical interposition graft in patients considered high risk for conventional thoracotomy. Long-term studies are necessary to determine the role of stent-grafts in preventing future aortic rupture.
Semba
C P
CP
Division of Cardiovascular, Interventional Radiology-Stanford University School of Medicine, Stanford University Medical Center, CA 94305, USA.
Kato
N
N
Kee
S T
ST
Lee
G K
GK
Mitchell
R S
RS
Miller
D C
DC
Dake
M D
MD
D000208:Acute Disease; D001013:Aorta, Thoracic / Q000293:injuries; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012421:Rupture; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed