title: Endovascular repair of thoracic aortic pathologies: postoperative nursing implications.
abstract: Endovascular stent grafting is increasingly used to manage descending thoracic aortic pathologies. The procedure was introduced at the study hospital in 2001. We sought to examine the short-term clinical outcomes of patients who underwent this endovascular stent grafting, with the aim of using the result as baseline for development of an in-center clinical management protocol. We undertook a single-center, retrospective review of health care records of patients managed with thoracic stent grafts from 2001 to 2009. Patient characteristics, in-hospital data, and procedural data were obtained. SPSS was used to analyze the data. A total of 30 patients were treated with thoracic stent; 23 were male, 7 were female, and the mean age was 55.0. Aortic pathologies treated were traumatic aortic dissection/transection (n = 15), acute/chronic aortic dissection (n = 9), and degenerative aneurysms (n = 6). Endoleak occurred in 3 patients, with 1 requiring further endograft repair. Two patients underwent combined open and endovascular repair of acute thoracic aortic dissection; 1 died 4 days after the procedure, and the other developed stroke and acute renal failure not requiring dialysis. Of the 28 patients who underwent endovascular repair, paraplegia and paraparesis occurred in 2 patients but resolved with cerebrospinal fluid drainage. Stroke occurred in 1 patient. Patients who underwent combined procedure of open and endovascular repair of thoracic aortic dissection had a greater risk of developing major adverse events than patients who underwent endovascular repair alone (Fisher's exact test P = .023). There was no association between the risk of stroke and the coverage of left subclavian artery in this series (P = .483). Graft stenting treatment for descending thoracic aortic pathologies has been shown to result in high in-hospital survival rates. It is essential for nurses who work in acute care settings to have knowledge of this procedure and potential complications associated with the procedure to enable postoperative assessment and immediate action if any deviation is observed.
authors.affiliation: Department of Vascular Surgery, Liverpool Hospital, Sydney, Australia. Electronic address: tanghua.chen@sswahs.nsw.gov.au.
authors.forename: Tanghua
authors.initials: T
authors.lastname: Chen
authors.affiliation: Liverpool Hospital, Sydney, Australia.
authors.forename: John A
authors.initials: JA
authors.lastname: Crozier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000451:nursing* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000451:nursing* / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000451:nursing*; D057867:Endoleak / Q000451:nursing*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000451:nursing*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009731:Nursing Audit; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome