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Ann Thorac Surg 1998;66:19-24
© 1998 The Society of Thoracic Surgeons

Original articles: cardiovascular

Endovascular stent graft repair for aneurysms on the descending thoracic aorta

Marek Ehrlich, MDa, Martin Grabenwoeger, MDa, Fabiola Cartes-Zumelzu, MDa, Michael Grimm, MDa, Dietmar Petzl, MDb, Johannes Lammer, MDc, Siegfried Thurnherc, Ernst Wolner, MDa, Michael Havel, MDa

a Department of Cardio-Thoracic Surgery, University of Vienna, Vienna, Austria
b Department of Medicine, University of Vienna, Vienna, Austria
c Department of Interventional Radiology, University of Vienna, Vienna, Austria

Address reprint requests to Dr Ehrlich, Department of Cardio-Thoracic Surgery, Mount Sinai Medical Center, One Gustave Levy Place, Box 1028, New York, NY 10029
e-mail: (mehrl98000{at}aol.com)

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

Background. The traditional treatment of aneurysms of the descending thoracic aorta includes posterolateral thoracotomy and aortic replacement with a prosthetic graft. In this study, we report our experiences and results in endovascular stent graft placement as an alternative to surgical repair.

Methods. Between January 1989 and July 1997, a total of 68 patients (24 women) underwent replacement of the thoracic aorta. Mean age at operation was 51 years. Fifty-eight patients underwent conventional surgical treatment. All of these patients were suitable candidates for endovascular stenting; however, no stent graft material was available at the time of operation. Ten patients (1 chronic dissection, 9 atherosclerotic aneurysm) received in the past 8 months the first commercially manufactured endovascular stent graft. The mean diameter of the aneurysms in this group was 7 cm (range, 6 to 8 cm). Two stent patients were operated on using only spinal cord analgesia. All stent grafts were custom designed for each of the 10 patients.

Results. The 30-day mortality in the conventional group was 31% versus 10% in the stent group. Mean length of intervention was 320 minutes in the conventional group versus 150 minutes in the endovascular group. Spinal cord injury occurred in 5 patients (12%) in the surgical group, whereas none of the stented patients developed any neurologic sequelae. Mean intensive care unit stay was 13 days, followed by a mean of 10 days on a ward in the first group compared to 4 days in the intensive care unit and 6 days on the ward in the stent group. One stent was required in 2 patients, two stents were required in 3 patients, and four stents were deployed in 5 patients of our series. Five patients required transposition of the left subclavian artery to achieve a sufficient neck for the proximal placement of the stent. There was complete thrombosis of the thoracic aortic aneurysm surrounding the stent graft in 8 patients (80%). Two patients required restenting as a result of leakage (20%). Stent graft placing was performed through the femoral artery in 8 patients, whereas access was only achieved through the abdominal aorta in 2 patients.

Conclusions. These preliminary results demonstrate that endovascular stent graft replacement might be a promising, cheaper, and safe alternative method in selected patients with descending thoracic aneurysms.




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