Chronic traumatic aneurysms of the descending thoracic aorta: mid-term results of endovascular repair using first and second-generation stent-grafts.
OBJECTIVE
Endovascular stent-graft repair holds promise for treating traumatic injuries of the descending thoracic aorta. The durability of this approach, however, remains unknown. The objective is to evaluate the mid-term results of stent-graft repair of chronic traumatic aneurysms of the descending thoracic aorta.


METHODS
Between 1993 and 2000, endovascular repair of the descending thoracic aorta with first (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 15 patients (mean age 54+/-13 years) at an average of 18+/-14 years after the injury. Because of comorbidities, 4 patients (27%) were judged not to be reasonable surgical candidates for conventional open surgical approach. Follow-up was 100% complete and averaged 55+/-29 months.


RESULTS
Stent-graft deployment was successful in all without need for surgical conversion. One patient died early postoperatively. No neurologic complications occurred. Two patients had a primary endoleak, one of them was successfully treated before discharge. Actuarial survival estimates at 1 and 6 years were 93+/-6% and 85+/-10%. Actuarial freedom from reintervention on the descending thoracic aorta was 93+/-6% and 70+/-15% at 1 and 6 years, respectively. Actuarial freedom from treatment failure (a conservative, all-encompassing performance indicator including endoleak, device mechanical fault, reintervention, late aortic-related death, or sudden, unexplained late death) at 1 and 6 years was 87+/-8% and 51+/-15%.


CONCLUSIONS
Stent-grafting is safe in selected patients with chronic traumatic aneurysms and associated with satisfactory-but not optimal-mid-term durability. Serial follow-up surveillance imaging is mandatory to detect late stent-graft complications. Younger, good risk patients should be offered conventional open operation, reserving stent-grafting for those who are at prohibitive operative risk or who have limited life expectancy.
Demers
Philippe
P
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, CA 94305, USA.
Miller
Craig
C
Scott Mitchell
R
R
Kee
Stephen T
ST
Lynn Chagonjian
R N
RN
Dake
Michael D
MD
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome