[Stent-graft treatment of the descending thoracic aorta in high risk patients].

PURPOSE: To report our experience with endovascular stent-graft repair of descending thoracic aorta diseases in high risk patients.

MATERIALS AND

METHODS

Between 2000 and 2007, 49 high surgical risk patients (mean age: 64.6 years) underwent stent-graft placement, including 24 cases presenting acutely. Mean follow-up was 25.4 months. Etiologies included 15 aneurysms, 11 dissections, 10 penetrating ulcers, 9 false aneurysms, 2 ruptures of the aortic isthmus, 2 intramural hematomas.

RESULTS

Access failure occurred in one patient. The overall mortality was 27.1% (n=13), nine related to the presenting pathology or treatment. Thirty-day mortality was 10.4% (n=5). Complications included vascular injury at the iliac or femoral artery access (10.2%), 1 case of flaccid paraplegia, 2 cases of transient paraparesis, 2 strokes, 2 stent migrations and 1 stent rupture. The rate of early endoleak was 39.6% while the rate of delayed endoleak was 14.6%. Seven patients (14.6%) required repeat endovascular interventions. Explantation was required in 2 cases. The latest available follow-up showed no lesion enlargement in 70.7% (n=29/41) of our patients.

CONCLUSION

Descending thoracic aortic pathology can be treated using endografts in high risk patients, although significant morbidity and mortality remain. Because of the high rate of endoleaks, close follow-up is required.