Stentgrafting of the thoracic aorta-complications.
Endovascular therapy (EVT) of thoracic aortic pathologies meanwhile is an established procedure with favourable midterm results in high risk patients. Different stent fabrications are available with defined flexibility, radial attachment force, metallic stent components and membrane porosities. Recent approval of the TAG Excluder (Gore) by the Food and Drug Administration (FDA) was an important step. Endoleaks, paraplegia, stroke and retrograde dissections are the main specific complications. Type I endoleak incidence rates are related to morphological case complexity; primary frequency rates of 0-20% are reported in the literature with 0-5% secondary incidence. Creating an appropriate proximal neck -- if necessary by supra-aortic branch remodelling -- and deliberate left subclavian artery overstenting is the key mechanism to avoid proximal endoleaks. Paraplegia rates are reportedly low with EVT in the range of 0-5%. Risk situations are: cases of rupture with compromised blood pressure, cases with a history of abdominal aortic aneurysm (AAA) exclusion, cases who require total overstenting of the descending thoracic aorta. The role of cerebrospinal fluid (CSF) drainage in EVT is not defined. Stroke as consequence of embolizing material from central endoaortic manipulations is almost in the same range as paraplegia, when morphologies in the distal arch are attacked. Retrograde dissection is reported not only after treatment of type B dissection but also after aneurysms. Rigid bare springs and ballooning in cases of type B dissection seem to be involved. In recent reports mortality in elective cases varies between 1.5% and 6.5%. All these data are promising but the proof of longterm durability is still lacking. Further development will show whether or not these preliminary data will translate into longterm success.
Sunder-Plassmann
L
L
Department of Thoracic and Vascular Surgery, University Hospital, Ulm, Germany. ludger.sunder-plassmann@medizin.uni-ulm.de
Orend
K H
KH
D000784:Aortic Dissection / Q000453:epidemiology / Q000209:etiology; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D001019:Aortic Rupture / Q000453:epidemiology / Q000209:etiology; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D010264:Paraplegia / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology