Midterm results of endovascular treatment of atherosclerotic aneurysms of the descending thoracic aorta.
OBJECTIVE
We sought to determine the midterm results of endovascular repair of atherosclerotic aneurysms of the thoracic descending aorta by using second-generation, commercially available stent grafts.


METHODS
Between 1996 and 2005, 45 patients (mean age, 68 +/- 11 years) with aneurysms of the descending thoracic aorta underwent endovascular repair. Aortic dissections, penetrating ulcers, and traumatisms were excluded. The mean follow-up was 24.7 +/- 21.6 months (maximum, 6.7 years).


RESULTS
No patients died, and no conversion to surgical intervention was required during the procedures. Three (6.7%) patients died during the first month, and 6 (14.7%) died later on. The main complications were strokes (13.3%), vascular access complications (8.9%), aortic complications (6.6%), paraplegia (4.4%), and sudden deaths (4.4%). Nineteen (42%) primary endoleaks were encountered: 3 required reinterventions, 15 spontaneously thrombosed, and 1 patient died. Except for 2 sudden unexplained deaths, no aortic complications were observed after 1 month. Actuarial survival estimates at 1, 3, and 5 years were 87.6% +/- 5.3%, 76.9% +/- 7.4%, and 70.6% +/- 9.2%, respectively. Actuarial freedom from death related to the treated aortic disease was 94.3% +/- 4.0%, 94.3% +/- 4.0%, and 86.4% +/- 8.4% at 1, 3, and 5 years, respectively. Aspirin status of greater than 3 (P = .005), high aortic diameter (P = .007), and long covered lengths (P = .02) were determinant for mortality. Actuarial freedom from complication was 62.6% +/- 7.7%, 58.9% +/- 8.1%, and 58.9% +/- 8.1% at 1, 3, and 5 years, respectively. The location of the aneurysm (P = .05) and a high aortic diameter (P = .04) were both determinants for endoleaks.


CONCLUSIONS
Stent grafting of atherosclerotic aneurysm of the thoracic descending aorta is safe and effective. Further studies are mandatory to determine the most relevant indications and the long-term efficacy of such treatment.
Marcheix
Bertrand
B
Department of Thoracic and Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France.
Dambrin
Camille
C
Bolduc
Jean-Philippe
JP
Arnaud
Catherine
C
Cron
Christophe
C
Hollington
Lucy
L
Mugniot
Antoine
A
Soula
Philippe
P
Bennaceur
Mehdi
M
Chabbert
Valérie
V
Massabuau
Pierre
P
Otal
Philippe
P
Cérène
Alain
A
Rousseau
Hervé
H
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000601:surgery*; D050197:Atherosclerosis / Q000150:complications*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome