title: Endovascular stent graft repair of abdominal and thoracic aortic aneurysms: a ten-year experience with 817 patients.
abstract: OBJECTIVE
  On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients.
  
  
  BACKGROUND
  Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality.
  
  
  METHODS
  Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed.
  
  
  RESULTS
  The mean age was 74.3 years (range, 25-95 years); 678 patients (83%) were men; 86% had 2 or more comorbid medical illnesses, 67% of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8% of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 +/- 6% at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 +/- 1% at 9 years. There was a 2.3% incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months.
  
  
  CONCLUSIONS
  Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms.
authors.affiliation: Departments of Surgery, Mount Sinai of Medicine, New York, NY 10029, USA. michael.marin@msnyuhelath.org
authors.forename: Michael L
authors.initials: ML
authors.lastname: Marin
authors.forename: Larry H
authors.initials: LH
authors.lastname: Hollier
authors.forename: Sharif H
authors.initials: SH
authors.lastname: Ellozy
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
authors.forename: Harold
authors.initials: H
authors.lastname: Mitty
authors.forename: Randall
authors.initials: R
authors.lastname: Griepp
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lookstein
authors.forename: Alfio
authors.initials: A
authors.lastname: Carroccio
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Morrissey
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Teodorescu
authors.forename: Tikva S
authors.initials: TS
authors.lastname: Jacobs
authors.forename: Michael E
authors.initials: ME
authors.lastname: Minor
authors.forename: Claudie M
authors.initials: CM
authors.lastname: Sheahan
authors.forename: Kristina
authors.initials: K
authors.lastname: Chae
authors.forename: Juliana
authors.initials: J
authors.lastname: Oak
authors.forename: Andrew
authors.initials: A
authors.lastname: Cha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome