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Eur J Cardiothorac Surg 2002;21:5-9
© 2002 Elsevier Science NL
a Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
b Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
c Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
d Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
Received 10 September 2001; received in revised form 26 October 2001; accepted 30 October 2001.
* Corresponding author. Tel.: +31-30-609-2047; fax: +31-30-609-2120
e-mail: rheijmen{at}hetnet.nl
Objective: 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, 28 descending TAA's were treated in 27 patients (17 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 (71%). They were predominantly localized in the proximal (32%), central (39%), and distal part (22%) of the descending thoracic aorta. In two patients (7%), the entire thoracic aorta was treated. Preliminary subclavian-carotid artery transposition was performed in five patients. AneurXTM (n=6), TalentTM (n=9), and ExcluderTM (n=13) stent-grafts were used. In 13 cases (46%), multiple stents were necessary for complete aneurysm exclusion. Results: In 27 of 28 cases (96%), 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 21 months (range, 1–49 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 eight patients (29%) during follow-up. In five of them the endoleaks sealed spontaneously, whereas in two patients a distal extension was inserted. Conclusions: 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.
Key Words: Endovascular • Stent-graft • Thoracic aortic aneurysm
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