Endovascular stent graft repair for aneurysms on the descending thoracic aorta.
BACKGROUND
The traditional treatment of aneurysms of the descending thoracic aorta includes posterolateral thoracotomy and aortic replacement with a prosthetic graft. In this study, we report our experiences and results in endovascular stent graft placement as an alternative to surgical repair.


METHODS
Between January 1989 and July 1997, a total of 68 patients (24 women) underwent replacement of the thoracic aorta. Mean age at operation was 51 years. Fifty-eight patients underwent conventional surgical treatment. All of these patients were suitable candidates for endovascular stenting; however, no stent graft material was available at the time of operation. Ten patients (1 chronic dissection, 9 atherosclerotic aneurysm) received in the past 8 months the first commercially manufactured endovascular stent graft. The mean diameter of the aneurysms in this group was 7 cm (range, 6 to 8 cm). Two stent patients were operated on using only spinal cord analgesia. All stent grafts were custom designed for each of the 10 patients.


RESULTS
The 30-day mortality in the conventional group was 31% versus 10% in the stent group. Mean length of intervention was 320 minutes in the conventional group versus 150 minutes in the endovascular group. Spinal cord injury occurred in 5 patients (12%) in the surgical group, whereas none of the stented patients developed any neurologic sequelae. Mean intensive care unit stay was 13 days, followed by a mean of 10 days on a ward in the first group compared to 4 days in the intensive care unit and 6 days on the ward in the stent group. One stent was required in 2 patients, two stents were required in 3 patients, and four stents were deployed in 5 patients of our series. Five patients required transposition of the left subclavian artery to achieve a sufficient neck for the proximal placement of the stent. There was complete thrombosis of the thoracic aortic aneurysm surrounding the stent graft in 8 patients (80%). Two patients required restenting as a result of leakage (20%). Stent graft placing was performed through the femoral artery in 8 patients, whereas access was only achieved through the abdominal aorta in 2 patients.


CONCLUSIONS
These preliminary results demonstrate that endovascular stent graft replacement might be a promising, cheaper, and safe alternative method in selected patients with descending thoracic aneurysms.
Department of Cardio-Thoracic Surgery, University of Vienna, Austria. mehrl98000@aol.com
M
M
Ehrlich
M
M
Grabenwoeger
F
F
Cartes-Zumelzu
M
M
Grimm
D
D
Petzl
J
J
Lammer
S
S
Thurnher
E
E
Wolner
M
M
Havel
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D000784:Aortic Dissection / Q000628:therapy; D001012:Aorta, Abdominal; D017545:Aortic Aneurysm, Thoracic / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D001161:Arteriosclerosis / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002406:Catheterization, Peripheral; D002908:Chronic Disease; D003422:Critical Care; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D013118:Spinal Cord Diseases / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D013348:Subclavian Artery / Q000601:surgery; D015996:Survival Rate; D013927:Thrombosis / Q000473:pathology; D013997:Time Factors