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Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta

^a Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
^b Department of Interventional Radiology, University of Vienna Medical School, Vienna, Austria

Received 16 September 2007; received in revised form 16 December 2007; accepted 21 December 2007.

^_* Corresponding author. Address: Waehringer Guertel 18-20, A-1090 Vienna, Austria. Tel.: +43 1 40 400 5643; fax: +43 1 40 400 5642. (Email: martin.czerny{at}meduniwien.ac.at).

Background: To determine mid-term durability of endovascular stent-graft placement in patients with penetrating atherosclerotic ulcers (PAU) involving the thoracic aorta and to identify risk factors for death as well as early and late cardiovascular events. Methods: From 1997 to 2006, 27 patients (mean age 66 yrs) presented with PAU (rupture n = 7). Mean numeric EuroScore was 11 and mean logistic EuroScore was 35. Median follow-up was 42 (10–86) months, being complete in all patients. Outcome variables included death and occurrence of early and late cardiovascular events. Results: In-hospital mortality was 11%. Primary success rate was 100%. Actuarial survival rates at 1, 3 and 5 years were 93%, 78% and 70%, respectively. Hemodynamic instability (HR 2.5, 2.1–3.9; p = 0.034) as well as logistic EuroScore (HR 2.8, 2.4–4.3; p = 0.019) was identified as independent predictor of early and late cardiovascular events. Conclusions: Endovascular stent-graft placement in patients with PAU is an effective palliation for a life-threatening sign of a severe systemic process. Hemodynamic instability at referral and a high preoperative risk score predict adverse outcome. During mid-term follow-up, patients are mainly limited by sequelae of their underlying disease.

Key Words: Penetrating • Atherosclerotic ulcer (PAU) • Arch rerouting • Endovascular stent-graft