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Eur J Cardiothorac Surg 2003;23:788-793
© 2003 Elsevier Science NL

Endovascular stent graft placement in patients with acute thoracic aortic syndromes

^a Department of Cardio-thoracic Surgery, University of Vienna, Leitstelle 20, Waehringer Guertel 18-20, 1090 Vienna, Austria
^b Department of Interventional Radiology and Angiography, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria

Received 5 September 2002; received in revised form 15 January 2003; accepted 22 January 2003.

^* Corresponding author. Tel.: +43-1-40400-5620, fax: +43-1-40400-5640
e-mail: martin.grabenwoeger{at}univie.ac.at

Objective: In the present study, the effectiveness of endovascular stent grafts (ESG) in the treatment of acute aortic complications, such as acute dissection type B, penetrating ulcer and traumatic aortic rupture is evaluated. Patients and methods: From June 1997 to February 2002, 66 patients were treated with ESG. Out of this cohort, 19 patients (28.8%) were subjected to stent grafting due to acute aortic syndromes. Acute dissection type B was present in 11 patients (16.6%), a penetrating ulcer was diagnosed in six patients (9%) and in 2 patients (3%) a traumatic aneurysm was the indication for operation. There were 16 male and three female patients with a mean age of 60 years (20–85 years). Excluder^TM stent grafts (Gore) were used in 15 patients, the Talent^TM device (Medtronic) was implanted in four patients. Results: Stent graft placement was technically successful in all patients. Hospital mortality was 0%. Paraparesis occurred in one patient (5.2%), which could be managed successfully without remaining neurological deficit after installation of cerebrospinal fluid drainage for 72 h. In another patient, overstenting of the left subclavian artery caused ischemia of the left arm and left subclavian to carotid artery bypass had to be performed. ICU-stay ranged from 1 to 6 days (mean 2.4 days) and the patients could be discharged after an average hospital stay of 8 days. In the follow-up period, one patient died due to myocardial infarction and one patient had to be re-operated due to contained rupture of the thoracic aorta caused by an endoleak. Conclusions: The study suggests that endovascular stent grafting is an excellent and effective treatment modality for the acute aortic accident, which can be recommended for high-risk patients too. However, close follow-up examination is indicated and long-term results have to be awaited to evaluate the real effectiveness of this method.

Key Words: Endovascular stent graft • Acute dissection type B • Traumatic aortic aneurysm • Penetrating ulcer

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