Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers.

Abstract

PURPOSE:

To present early and midterm results after endovascular stent graft repair of patients with penetrating aortic ulcers (PAU).

METHODS:

Between January 1997 and March 2008, a total of 202 patients received thoracic aortic endografting in our institution, 48 patients (32 men, median age 70 years, range, 48-89) with PAU. A retrospective analysis of these patients was performed. Thirty-one patients (65%) showed an acute aortic syndrome (8 contained rupture, 23 symptomatic). Follow-up scheme included postoperative computed tomography angiography prior to discharge, at 3, 6, and 12 months, and yearly thereafter. Mean follow-up was 31.3 months (1.3-112.6).

RESULTS:

Technical success was achieved in 93.7%. Primary clinical success rate was 81.2%. In-hospital mortality was 14.6%. Perioperative mortality was significantly (P = .036) higher in patients with acute aortic syndrome compared to asymptomatic patients (22.5% vs 0%). Postoperative complications occurred in 15 patients (31%), including 2 patients with minor strokes and 6, respectively, 5 patients with cardiac and/or respiratory complications. Early endoleaks were observed in 9 patients (19%), late endoleaks in another 2 patients. Reintervention was necessary in 4 out of 48 patients (8.4%). The actuarial survival estimates at 1, 3, and 5 years were 78% +/- 6%, 74% +/- 7%, and 61% +/- 10%, respectively. There was no aortic-related death during follow-up. Cox regression showed age (hazard ratio [HR]; 1.08, P = .036) and a maximum aortic diameter >50 mm (HR, 4.92; P = .021) as independent predictors of death.

CONCLUSION:

Endovascular treatment of penetrating aortic ulcers is associated with a relevant morbidity and mortality rate in frequently highly comorbid patients. Midterm results could prove a sustained treatment success regarding actuarial survival and aortic-related death. Emergencies show a significantly worse outcome, but treatment is still warranted in these symptomatic patients.

• Authors: Philipp Geisbüsch, Drosos Kotelis, Tim F Weber, Alexander Hyhlik-Dürr, Hans-Ulrich Kauczor, Dittmar Böckler
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 48 Issue 6 Pg. 1361-8 (Dec 2008) ISSN: 1097-6809 [Electronic] United States
• PMID: 18829235 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Aged, 80 and over
• Angioscopy (methods)
• Aorta, Thoracic
• Aortic Diseases (diagnosis, surgery)
• Blood Vessel Prosthesis
• Female
• Follow-Up Studies
• Humans
• Magnetic Resonance Angiography
• Male
• Middle Aged
• Retrospective Studies
• Rupture, Spontaneous
• Stents
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Ulcer (diagnosis, surgery)