Disease of the thoracic aorta pose a significant challenge to the surgeons because of the complexity of the disease. Frequent comorbidities and increasing age are responsible for high mortality rates. The aim of this study was to evaluate the feasibility, safety and clinical outcome of endovascular stent-graft (ESG) placement in patients with type B dissection and descending aorta aneurysm.
Between February 2000 and June 2001, ESG was used in 21 patients (pts) with a mean age of 65 years (range 30-84). Descending aorta aneurysm was the indication in 15 pts: arch with descending aorta (n=1), descending only (n=4), saccular (n=2), thoraco-abdominal aneurysm (n=2), chronic traumatic isthmic rupture (n=2), chronic dissection type B (n=4). Three pts were operated in emergency for a ruptured atherosclerotic aneurysm . Acute type B dissection was the indication in 6 patients with persistent thoracic pain. Vascular access was achieved through femoral cut-down and successful deployment of the ESG was obtained in all patients. In all but two pts with acute type B dissection, closure of the entry tear and thrombosis of the false lumen along the stent-graft were achieved. A successfully repeat stenting was done in these 2 pts. Thoracic aneurysm was excluded in all 15 pts. One pt presented a type II endoleak at follow-up. Hospital mortality and paraplegia was 0%. Two pts presented a TIA postoperatively.
In conclusion, ESG repair is a promising and less invasive alternative to treat type B dissection and to exclude aneurysm from blood flow.