Stent grafting of dissected descending aorta in patients with Marfan's syndrome: mid-term results.
OBJECTIVE
This study sought to assess the safety and the effectiveness of endovascular stent grafting of chronic aortic dissection (AD) in Marfan patients.


BACKGROUND
The management of chronic AD of the descending thoracic aorta (DTA) is challenging. This is especially true in Marfan patients, who tend to exhibit poor short- and long-term results after conventional surgery.


METHODS
Fifteen patients with Marfan's syndrome and chronic AD of the DTA were identified among the 457 patients of the European Talent Registry. All patients underwent endovascular treatment.


RESULTS
No major adverse event was encountered during the procedure. Five patients experienced a primary endoleak (type 1, n = 4; type 2, n = 1). Three of them died, and 1 underwent successful conversion to open surgery. Five other patients experienced secondary endoleak (type 1, n = 4; type 3, n = 1). Four of them underwent successful conversion to either open or endovascular reintervention. Two other patients underwent successful conversion to open repair because of secondary aortic enlargement below the stent graft. After a mean follow-up of 2.1 +/- 1.4 years, 12 patients are alive. Of these 12, conversion to open repair was successfully performed in 5 patients. In the remaining 7 patients, complete thrombosis of the false lumen was achieved in 6 patients, with partial thrombosis in 1 patient.


CONCLUSIONS
Endovascular stent grafting of the dissected DTA is feasible in selected Marfan patients with low mortality and morbidity rates. Nevertheless, the rate of primary and secondary endoleak is high. Close imaging surveillance is crucial to detect secondary aortic complications and to assess long-term results.
Marcheix
Bertrand
B
Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France.
Rousseau
Hervé
H
Bongard
Vanina
V
Heijmen
Robin H
RH
Nienaber
Christoph A
CA
Ehrlich
Marek
M
Amabile
Philippe
P
Beregi
Jean-Paul
JP
Fattori
Rossela
R
D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002908:Chronic Disease; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult