Avoidance of proximal endoleak using a hybrid stent graft in arch replacement and descending aorta stenting.
BACKGROUND
In complex thoracic aortic procedures, proximal repair and antegrade stent grafting of the descending aorta is an emerging technique to achieve one-stage treatment of the thoracic aorta. To overcome problems of proximal endoleak, a hybrid stent graft was designed and used. This study assessed technical feasibility and early results.


METHODS
From Jan 2005 to May 2008, 41 patients (age, 60 +/- 13 years) comprising 35 aortic dissections (AD) and 6 aortic aneurysms underwent arch replacement and antegrade stent grafting of the descending aorta using the hybrid stent graft. Endoleaks were evaluated by computed tomography (CT) scans. In AD cases, the false lumen (FL) was evaluated with CT volume measurements.


RESULTS
Combined arch replacement and antegrade stent grafting was technically successful. One proximal endoleak was observed, which was not related to the hybrid prosthesis (40 of 41, 98%). Three patients died (7%). No paraplegia occurred. Incidence of immediate FL thrombosis was 97% at the proximal and 80% at the distal stent graft level. During follow-up (17 +/- 11 months), complete thrombosis of the perigraft space was 91%. FL volume shrinkage was documented (p < 0.01). No perfusion of the perigraft space was observed in aneurysm cases. Intermediate survival was 33 of 38 (87%).


CONCLUSIONS
One-stage repair of complex thoracic aortic disease using a hybrid stent graft can be reliably performed with low hospital mortality. Proximal endoleak can be definitely avoided; in AD, exclusion and ongoing significant shrinkage of the FL can be achieved.
Tsagakis
Konstantinos
K
Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen, Essen, Germany. konstantinos.tsagakis@uk-essen.de
Kamler
Markus
M
Kuehl
Hilmar
H
Kowalczyk
Wojciech
W
Tossios
Paschalis
P
Thielmann
Matthias
M
Osswald
Brigitte
B
Erbel
Raimund
R
Eggebrecht
Holger
H
Jakob
Heinz
H
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000517:prevention & control*; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed