Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta.
OBJECTIVE
The aim of this study was to evaluate the feasibility, safety, and effectiveness of endovascular stent-graft placement for the emergency treatment of acute descending thoracic aortic disease.


METHODS
From January 1996 through November 2001, 18 patients underwent emergency endovascular stent-graft placement for various types of acute descending thoracic aortic disease. Five patients had Stanford type B aortic dissection, six had traumatic ruptures of the thoracic aorta, five had ruptured aortic aneurysms, and two had penetrating atherosclerotic aortic ulcers. All patients presented with life-threatening symptoms requiring treatment with stent-grafts from the emergency kit. All were at high surgical risk due to serious comorbidities. The efficacy of the procedure was assessed at follow-up studies before discharge and at 3, 6, and 12 months after intervention and yearly thereafter.


RESULTS
The primary technical success rate was 78%. Four patients had primary perigraft leaks. The secondary technical success rate was 83%. One patient died 20 hr after intervention from stent-graft-related causes. Follow-up studies revealed stent-graft migration in one patient. Progression of disease was observed in one patient treated for dissection and in both patients treated for penetrating ulcers. One patient died 7 months after intervention of unknown reasons; all other patients are alive. The mean follow-up time was 17.4 months (range, 0-38 months).


CONCLUSIONS
Emergency repair of acute descending thoracic aortic disease with stent-graft placement can be successfully accomplished and may be a promising alternative to open-chest surgery, especially in patients at high risk.
Czermak
Benedikt V
BV
Department of Radiology, Kurt Amplatz Center, Leopold-Franzens Medical School and University Hospital Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
Waldenberger
Peter
P
Perkmann
Reinhold
R
Rieger
Michael
M
Steingruber
Iris E
IE
Mallouhi
Ammar
A
Fraedrich
Gustav
G
Jaschke
Werner R
WR
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D001161:Arteriosclerosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents; D014456:Ulcer / Q000601:surgery