Endovascular repair of thoracic aortic pathology with custom-made devices.
BACKGROUND
Open repair of thoracic aortic aneurysms (TAAs) is fraught with high morbidity and mortality rates. The availability of endoprostheses for treating thoracic aortic pathology has not kept pace with those for treating abdominal aneurysms. Technical feasibility, durability, and safety of custom-made stent-grafts for the treatment of TAAs and dissections are evaluated.


METHODS
From July 2002 to October 2004 there were 15 patients with TAAs, intramural hematoma, or dissections treated with custom-made endografts. Grafts were deployed after brief adenosine-induced cardiac arrest. Computed tomography scans were obtained 1 month postoperatively and every 6 months thereafter. The mean follow-up period was 15 months (range, 3-31 mo).


RESULTS
The mean age of patients was 67 +/- 11 years (range, 47-81 y; 67% men, 33% women). Indications for repair included TAA (10), chronic type B dissection (3), penetrating ulcer (1), and acute dissection (1). Planned concomitant procedures included subclavian-carotid transposition (2) and aortosplenic bypass (2) to achieve adequate proximal or distal landing seal zones, respectively. The mean length of hospital stay was 8 days (range, 1-49 d). Immediate complications included 2 access-related events, 1 cerebellar infarction treated expectantly, and 1 death from a large hemispheric stroke. There were no cases of postoperative paralysis and on follow-up imaging no cases of endoleak, endograft migration, or stent fractures were found. No late deaths occurred caused by stent-graft repair or aneurysm-related causes.


CONCLUSIONS
Endoluminal exclusion of thoracic aortic aneurysms and dissections can be achieved successfully using custom-made stent-grafts. The use of specially designed devices appears to be technically feasible and durable, with acceptable morbidity and mortality rates.
Peterson
Brian G
BG
Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Longo
G Matthew
GM
Matsumura
Jon S
JS
Kibbe
Melina R
MR
Morasch
Mark D
MD
Cardeira
Kelley R
KR
Eskandari
Mark K
MK
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed