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Eur J Cardiothorac Surg 2005;28:478-482
© 2005 Elsevier Science NL

Original articles

Endovascular repair for concomitant multilevel aortic disease

^a Postgraduate School in Vascular Surgery—Department of Surgery, University of Insubria, Ospedale di Circolo, 21100 viale Borri 57, Varese, Italy
^b Department of Radiology, University of Insubria, Varese, Italy
^c Anesthesia and Palliative Care, University of Insubria, Varese, Italy

Received 12 April 2005; received in revised form 23 May 2005; accepted 25 May 2005.

^* Corresponding author. Tel.: +39 3322 78226; fax: +39 3322 60260. (Email: lelepiffa74{at}libero.it).

Abstract

OBJECTIVE: Patients with multilevel aortic disease represent a small subgroup with the need for extensive surgical treatment at considerable risk. We present our experience of endovascular exclusion for simultaneous thoracic and abdominal aortic disease in four patients. Methods: Between January 2002 and January 2005, four patients underwent endovascular repair for simultaneous thoracic and abdominal aortic disease. Mean age was 69±10 years (range, 60–81). Thoracic lesions included penetrating aortic ulcer (n=2, ruptured=1), atherosclerotic aneurysm (n=1), and chronic type B dissection (n=1). Abdominal aortic disease included atherosclerotic infrarenal (n=3) and juxtarenal (n=1) aortic aneurysms. Thoracic aortic stent-grafts had been the following: Excluder/TAG (n=3) or Talent (n=1) straight tube devices. Abdominal aortic stent-grafts used were as following: Excluder (n=3) or Zenith (n=1). All patients were followed-up with CT-angiography and chest X-rays 1, 4, 12 months after the procedure, and once per year thereafter. Results: Stent-graft deployment was technically successful in all cases. Intraoperative mortality was not observed. Mean procedure time was 94±34min (range, 70–145). Early postoperative complications occurred in one patient that developed acute renal failure but dialysis was not required. Mean hospitalisation was 8±5 days (range, 4–15). Late death occurred in one patient for an undetected ruptured thoracic type 1 endoleak. All three survivors are currently well 16.5 months (range, 3–36) after surgery. No neurological complications developed. Conclusion: Simultaneous abdominal and thoracic endovascular repair for multilevel aortic disease is feasible and could be a viable alternative in high-risk patients, who otherwise may not be suitable candidates for conventional repair.

Key Words: Multilevel aortic disease • Endovascular repair • Stent-graft • Penetrating aortic ulcer