Stent-graft placement for the treatment of thoracic aortic diseases.
The recent development of aortic stent-grafts has brought the management of thoracic aortic diseases into the realm of interventional radiology. Stent-graft placement is now an alternative to surgery for the treatment of descending thoracic aortic aneurysms, ulcers, and fistulas and is sometimes indicated in cases of mycotic aneurysm, posttraumatic aortic rupture, or thoracic descending aortic dissection. Pretreatment imaging is crucial for evaluating patient eligibility, selecting the appropriate stent-graft, and planning the intervention. Stent-graft treatment of long atherosclerotic aneurysms, lesions close to aortic branch vessels, and aortic dissections is subject to technical pitfalls, and adverse events such as endoleaks, stent migration or misplacement, aortic perforation, and vascular trauma will require specific interventions, although they occur in only a minority of patients. Thoracic stent-graft placement in good surgical candidates remains controversial because long-term results are unknown. However, short-term morbidity and mortality rates from endovascular treatment compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases and is already the best option in many affected patients who are poor surgical candidates.
Therasse
Eric
E
Department of Radiology, Centre Hospitalier de l'Université de Montréal-Hôtel-Dieu, 3840 St-Urbain St, Montreal, Quebec, Canada H2W 1T8. eric.therasse.chum@ssss.gouv.qc.ca
Soulez
Gilles
G
Giroux
Marie-France
MF
Perreault
Pierre
P
Bouchard
Louis
L
Blair
Jean-François
JF
Beaudoin
Nathalie
N
Benko
Andrew
A
Oliva
Vincent L
VL
D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D003131:Combined Modality Therapy; D004867:Equipment Design; D006801:Humans; D011474:Prosthesis Design; D015607:Stents / Q000009:adverse effects