Endograft therapy for diseases of the descending thoracic aorta: results in 43 high-risk patients.
OBJECTIVE
To report an initial experience with endovascular stent-graft implantation for diseases of the descending thoracic aorta in high-risk patients.


METHODS
Forty-three patients (28 men; mean age 67 years, range 17-82) with 16 descending thoracic aortic dissections, 14 aneurysms, 7 contained ruptures, 3 mycotic aneurysms, 2 posttraumatic pseudoaneurysms, and an aneurysm of an anomalous right subclavian artery were treated between June 1999 and July 2001. Twenty-three (53%) patients were treated emergently.


RESULTS
There were no conversions to open repair, but 3 (7%) patients died during the first 30 days (pneumonia, multiorgan failure, and acute bowel ischemia). Thirteen (30%) patients suffered 18 major complications (8 strokes, paraplegia in 3, respiratory insufficiency in 6, and 1 renal failure). Of 7 (16%) endoleaks detected in the early postoperative period, 3 required additional stents, while the other 4 were treated conservatively. Follow-up, which averaged 19 +/- 6 months (median: 13; range 0-34), was 100% complete. Five (12%) patients died: 3 of aortic rupture at 34, 47, and 139 days, respectively, and 2 from heart failure at 3 and 15 months, respectively. No late migration or endoleaks have been detected in the remaining 35 patients; however, 1 (2%) patient showed progressive aortic dissection proximal to the stent-graft. In all other cases, the size of the aneurysm or the false lumen was unchanged or diminished.


CONCLUSIONS
Treatment of descending thoracic aortic diseases with an endovascular approach has acceptable early mortality and morbidity in high-risk patients. In selected cases, stent-grafts may afford the best therapy.
Lepore
Vincenzo
V
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. vincenzo.lepore@vgregion.se
Lönn
Lars
L
Delle
Martin
M
Bugge
Mogens
M
Jeppsson
Anders
A
Kjellman
Ulf
U
Rådberg
Göran
G
Risberg
Bo
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000453:epidemiology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000601:surgery*; D001019:Aortic Rupture / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D013548:Sweden; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures