title: Acute rupture of the descending thoracic aorta: repair with use of endovascular stent-grafts.
abstract: 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.
authors.affiliation: Division of Cardiovascular, Interventional Radiology-Stanford University School of Medicine, Stanford University Medical Center, CA 94305, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Semba
authors.forename: N
authors.initials: N
authors.lastname: Kato
authors.forename: S T
authors.initials: ST
authors.lastname: Kee
authors.forename: G K
authors.initials: GK
authors.lastname: Lee
authors.forename: R S
authors.initials: RS
authors.lastname: Mitchell
authors.forename: D C
authors.initials: DC
authors.lastname: Miller
authors.forename: M D
authors.initials: MD
authors.lastname: Dake
mesh_terms: 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