Introduction : Endoluminal placement of covered stent-grafts emerges as a less-invasive alternative to open surgical repair of thoracic aortic aneurysms (TAA). The present report describes our experience with endovascular stent-grafting in the treatment of descending TAA.
Methods : From 1997 to 2001, 29 descending TAA’s were treated in 28 patients (18 male, mean age 70 years) by endovascular stent-grafting. The aneurysms (mean diameter, 6.6 cm) had diverse causes, but the majority were due to atherosclerosis (69%). They were predominantly localized in the proximal (34%), central (38%), and distal part (21%) of the descending thoracic aorta. In 2 patients (7%), the entire thoracic aorta was treated. Preliminary subclavian-carotid artery transposition was performed in 6 patients. AneurX™ (n=6), Talent™ (n=10), and Excluder™ (n=13) stent-grafts were used. In 13 cases (45%), multiple stents were necessary for complete aneurysm exclusion.
Results : In 28 of 29 cases (97%), the endovascular stent-grafts were successfully deployed. In one patient, stent dislocation into the aneurysm required open surgical repair in a subsequent procedure. There was no operative mortality. None of the patients developed paraplegia or paraparesis. No distal embolization occurred. After a median follow-up of 22 months (range, 2 to 50 months), there was one non-related late death. There was no aneurysm rupture. Maximal aneurysm diameter either remained stable or decreased slightly over time in all but one patient with evidence of an endoleak. Endoleaks occurred in 28% of cases during follow-up. In the majority the endoleaks sealed spontaneously, whereas in 2 patients a distal extension was inserted.
Conclusion : Endovascular repair of descending TAA’s is a promising less-invasive alternative to open repair. Extended follow-up is necessary to determine its definite efficacy in the longer term.