Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the feasibility, safety, and effectiveness of endovascular stent-graft placement for the emergency treatment of acute descending thoracic aortic disease.

MATERIALS AND METHODS:

From January 1996 through November 2001, 18 patients underwent emergency endovascular stent-graft placement for various types of acute descending thoracic aortic disease. Five patients had Stanford type B aortic dissection, six had traumatic ruptures of the thoracic aorta, five had ruptured aortic aneurysms, and two had penetrating atherosclerotic aortic ulcers. All patients presented with life-threatening symptoms requiring treatment with stent-grafts from the emergency kit. All were at high surgical risk due to serious comorbidities. The efficacy of the procedure was assessed at follow-up studies before discharge and at 3, 6, and 12 months after intervention and yearly thereafter.

RESULTS:

The primary technical success rate was 78%. Four patients had primary perigraft leaks. The secondary technical success rate was 83%. One patient died 20 hr after intervention from stent-graft-related causes. Follow-up studies revealed stent-graft migration in one patient. Progression of disease was observed in one patient treated for dissection and in both patients treated for penetrating ulcers. One patient died 7 months after intervention of unknown reasons; all other patients are alive. The mean follow-up time was 17.4 months (range, 0-38 months).

CONCLUSION:

Emergency repair of acute descending thoracic aortic disease with stent-graft placement can be successfully accomplished and may be a promising alternative to open-chest surgery, especially in patients at high risk.

• Authors: Benedikt V Czermak, Peter Waldenberger, Reinhold Perkmann, Michael Rieger, Iris E Steingruber, Ammar Mallouhi, Gustav Fraedrich, Werner R Jaschke
• Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 179 Issue 2 Pg. 337-45 (Aug 2002) ISSN: 0361-803X [Print] United States
• PMID: 12130430 (Publication Type: Journal Article)

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Aortic Dissection (surgery)
• Aorta, Thoracic (diagnostic imaging, surgery)
• Aortic Aneurysm (surgery)
• Aortic Diseases (diagnostic imaging, surgery)
• Aortic Rupture (surgery)
• Arteriosclerosis (surgery)
• Blood Vessel Prosthesis Implantation
• Emergencies
• Female
• Humans
• Male
• Middle Aged
• Radiography
• Stents
• Ulcer (surgery)