title: Endovascular stent-grafting for diseases of the descending thoracic aorta.
abstract: BACKGROUND
  Endoluminal stent-grafts are emerging as a less invasive alternative to conventional open surgery in the management of descending thoracic aortic dissections and aneurysms. We describe our experience with endovascular stent-grafting in the treatment of thoracic aorta pathology.
  
  
  METHODS
  17 Patients were treated with 23 endovascular stents. The underlying pathology was an atherosclerotic aneurysm verum (n = 5), a type B dissection with contained rupture (n = 3), an intramural haematoma with contained rupture (n = 1) and a false aneurysm of unknown origin (n = 1). One patient had Marfan's syndrome and six patients had a traumatic rupture of the descending aorta.
  
  
  RESULTS
  Overall 23 stent-grafts were implanted. In one patient, conversion to an open graft replacement of the descending aorta was necessary. One patient died. In four patients (23.5%) a left carotid-subclavia bypass or transposition was performed to achieve a sufficient neck for the proximal stent-graft landing zone. The postoperative control-CT scans revealed a total of six endoleaks (EL) (four type I, one type II and one type IV). Two patients needed a graft extension in a second operation (4 days and 18 month after the first operation), two EL (one type I and one type II) disappeared after 9 and 18 months, respectively and two EL are still under observation. One patient developed a paresis after conversion to open graft replacement.
  
  
  CONCLUSIONS
  A variety of diseases of the descending aorta can be treated by endoluminal stent-grafting, which seems to be a valid alternative to open repair in well selected cases. Mortality and morbidity in our small series were low. Continuous follow-up is mandatory.
authors.affiliation: Division of Angiology, Clinic for Cardiovascular Surgery, University Hospital Berne, CH-3010 Berne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Gerber
authors.forename: F F
authors.initials: FF
authors.lastname: Immer
authors.forename: D D
authors.initials: DD
authors.lastname: Do
authors.forename: T
authors.initials: T
authors.lastname: Carrel
authors.forename: J
authors.initials: J
authors.lastname: Schmidli
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology; D001018:Aortic Diseases / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012421:Rupture; D015607:Stents