[Analysis of quality of endovascular treatment of thoracic aortic diseases].
In contrast to the uniform aneurysms of the infrarenal abdominal aorta endovascular therapy in the thoracic aorta deals with diverse aortic pathologies, which can be broadly grouped into aneurysms, dissections, traumatic ruptures and pseudoaneurysms. Further emergency situations such as free or contained rupture, impending rupture, aorto-bronchial fistula or malperfusion in acute dissections determine endovascular therapy, which is often considered the last therapeutic option in these situations. In this article published studies with relevant numbers of cases and our own results are analyzed. Especially regarding 30-day mortality marked differences are found between controlled multicenter studies, multicenter registries and single center studies due to differing study design and exclusion criteria. Depending on the proportion of emergency cases, 30-day mortality of between 5 and 13% is a clinical reality in thoracic stent grafting. The incidence of spinal cord ischemia is between 2 and 9% and incidence of perioperative stroke between 2 and 5%. To establish quality standards more data differentiated between the different aortic pathologies, emergency situations and sites of implantation are mandatory.
Zipfel
B
B
Herz-, Thorax- und Gefässchirurgie, Deutsches Herzzentrum Berlin. zipfel@dhzb.de
Buz
S
S
Hetzer
R
R
D017541:Aneurysm, False / Q000453:epidemiology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001604:Berlin / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000592:standards; D018849:Controlled Clinical Trials as Topic; D004630:Emergencies; D005858:Germany; D006801:Humans; D015337:Multicenter Studies as Topic; D019990:Perioperative Care / Q000009:adverse effects; D011785:Quality Assurance, Health Care; D011859:Radiography; D012042:Registries; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000401:mortality