[Stent-graft implantation in the thoracic aorta. Results of an interdisciplinary survey in Germany].
OBJECTIVE
Endovascular stent-graft placement is emerging as a novel therapeutic option in patients with disease of the descending thoracic aorta. Quality standards for performing stent-graft procedures as well as for pre- and postoperative patient management are lacking, so far. It was the aim of this present survey to assess the current therapeutic standard of thoracic aortic stent-graft placement in Germany.


METHODS
In a nationwide survey, a total of 206 vascular surgical, radiologic, cardiologic, and cardiothoracic surgical departments were contacted. Data concerning preoperative procedure planning, logistics, practical/technical issues of stent-graft placement, and postoperative patient management were evaluated using a standardized questionnaire comprising 29 items. Data analysis was performed using univariate analysis.


RESULTS
184 (89.3 %) of the 206 departments participated in the survey. Of these, 71 centers reported intending to perform or having performed thoracic aortic stent-graft placement. The survey overall represents 2267 endovascular stent-graft procedures performed in Germany between 1997/98 and 2003. On average, 7.4 stent-graft procedures/year were performed by each center, with half the centers performing fewer than 5 procedures/year. Thoracic aortic aneurysms was the main indication for endovascular stent-graft placement, followed by aortic dissection. There were significant differences between the different medical specialties which perform stent-graft procedures with respect to indications, choice of preoperative and intraoperative imaging methods, and technical equipment. There was strong agreement between the different centers concerning the necessity of a life-long follow-up after stent-graft placement, with computed tomography being the preferred imaging technique (90 % of centers).


CONCLUSIONS
The present survey documents an increasing use of endovascular stent-graft placement in patients with disease of the descending thoracic aorta. There were differences regarding the technical execution of this procedures between specialties with respect to indication, procedure planning, and practical-technical aspects of stent-graft placement.
Eggebrecht
H
H
Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universität Duisburg-Essen. holger.eggebrecht@uni-essen.de
Pamler
R
R
Zipfel
B
B
Herold
U
U
Chavan
A
A
Rehders
T C
TC
Hetzer
R
R
Nienaber
C A
CA
Jakob
H G
HG
Erbel
R
R
D000704:Analysis of Variance; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care; D005858:Germany; D006801:Humans; D010347:Patient Care Planning; D019990:Perioperative Care; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D011787:Quality of Health Care; D015607:Stents / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome