Endovascular treatment of thoracic disease: patient selection and a proposal of a risk score.
BACKGROUND
Although selection criteria and subgroup analysis are still in the early developmental stages, endovascular treatment of aortic disease has become an alternative to surgery for many patients.


METHODS
From November 1996 to November 1999, 49 patients were treated with a self-expandable endoprosthesis at our institution. Most patients had acute aortic dissections. Thirteen of these patients did not follow the anatomic selection protocol. We retrospectively analyzed these patients to compare our numerical risk score (which includes clinical and anatomic criteria) between groups with or without success and between groups that followed the anatomic protocol (P) or did not follow the anatomic protocol (E [exception]).


RESULTS
Success rates were similar in groups P and E, although mortality rates were higher in group E. Patients from group E had longer procedures and required multiple stents more frequently. The proposed risk score was able to differentiate between groups with or without success, as well as between groups P and E.


CONCLUSIONS
In order to reduce mortality and morbidity rates, careful selection criteria must be followed when treating patients endovascularly. Although it is time-consuming, using objective criteria can help select patients for endovascular treatment. We propose that patients with a risk score higher than 11 should only undergo percutaneous treatment when they have an unacceptably high surgical risk, and even so only after a detailed discussion of the risks.
Rodrigues Alves
Claudia Maria
CM
Federal University of Sao Paulo, Paulista School of Medicine, São Paulo, Brazil. cmralves@uol.com.br
da Fonseca
José Honório Palma
JH
de Souza
José Augusto Marcondes
JA
Camargo Carvalho
Antonio Carlos
AC
Buffolo
Enio
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000145:classification / Q000628:therapy*; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000628:therapy*; D002406:Catheterization, Peripheral; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012372:ROC Curve; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome