Endovascular stent graft repair for aneurysms on the descending thoracic aorta

Autor: Johannes Lammer, Siegfried Thurnher, Ernst Wolner, Fabiola Cartes-Zumelzu, Michael Havel, Marek Ehrlich, Dietmar Petzl, Martin Grabenwoeger, Michael Grimm
Rok vydání: 1998
Předmět:
Adult
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Critical Care
Arteriosclerosis
medicine.medical_treatment
Subclavian Artery
Anesthesia
General
Anesthesia
Spinal
Thoracic aortic aneurysm
Spinal Cord Diseases
Blood Vessel Prosthesis Implantation
Aortic aneurysm
Aneurysm
medicine.artery
Catheterization
Peripheral
medicine
Humans
Thoracic aorta
Aorta
Abdominal
cardiovascular diseases
Aged
Aortic Aneurysm
Thoracic
business.industry
Abdominal aorta
Stent
Thrombosis
Equipment Design
Length of Stay
Middle Aged
equipment and supplies
medicine.disease
Surgery
Femoral Artery
Survival Rate
Aortic Dissection
surgical procedures
operative
Cardiothoracic surgery
Descending aorta
Chronic Disease
Retreatment
Female
Stents
Radiology
Cardiology and Cardiovascular Medicine
business
Zdroj: The Annals of Thoracic Surgery. 66:19-24
ISSN: 0003-4975
DOI: 10.1016/s0003-4975(98)00390-7
Popis: Background. The traditional treatment of aneurysms of the descending thoracic aorta includes posterolateral thoracotomy and aortic replacement with a prosthetic graft. In this study, we report our experiences and results in endovascular stent graft placement as an alternative to surgical repair. Methods. Between January 1989 and July 1997, a total of 68 patients (24 women) underwent replacement of the thoracic aorta. Mean age at operation was 51 years. Fifty-eight patients underwent conventional surgical treatment. All of these patients were suitable candidates for endovascular stenting; however, no stent graft material was available at the time of operation. Ten patients (1 chronic dissection, 9 atherosclerotic aneurysm) received in the past 8 months the first commercially manufactured endovascular stent graft. The mean diameter of the aneurysms in this group was 7 cm (range, 6 to 8 cm). Two stent patients were operated on using only spinal cord analgesia. All stent grafts were custom designed for each of the 10 patients. Results. The 30-day mortality in the conventional group was 31% versus 10% in the stent group. Mean length of intervention was 320 minutes in the conventional group versus 150 minutes in the endovascular group. Spinal cord injury occurred in 5 patients (12%) in the surgical group, whereas none of the stented patients developed any neurologic sequelae. Mean intensive care unit stay was 13 days, followed by a mean of 10 days on a ward in the first group compared to 4 days in the intensive care unit and 6 days on the ward in the stent group. One stent was required in 2 patients, two stents were required in 3 patients, and four stents were deployed in 5 patients of our series. Five patients required transposition of the left subclavian artery to achieve a sufficient neck for the proximal placement of the stent. There was complete thrombosis of the thoracic aortic aneurysm surrounding the stent graft in 8 patients (80%). Two patients required restenting as a result of leakage (20%). Stent graft placing was performed through the femoral artery in 8 patients, whereas access was only achieved through the abdominal aorta in 2 patients. Conclusions. These preliminary results demonstrate that endovascular stent graft replacement might be a promising, cheaper, and safe alternative method in selected patients with descending thoracic aneurysms.
Databáze: OpenAIRE
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