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Ann Thorac Surg 2008;85:S1-S41. doi:10.1016/j.athoracsur.2007.10.099
© 2008 The Society of Thoracic Surgeons
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Lars G. Svensson
Nicholas T. Kouchoukos
D. Craig Miller
Joseph E. Bavaria
Joseph S. Coselli
John A. Elefteriades
Raimund Erbel
Thomas G. Gleason
Bruce W. Lytle
Eric E. Roselli
Hazim J. Safi
Richard J. Shemin
Thoralf M. Sundt, III
Wilson Y. Szeto
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Report From The Society of Thoracic Surgeons Endovascular Surgery Task Force

Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts*

Lars G. Svensson, MD, PhDa,*, Nicholas T. Kouchoukos, MDb, D. Craig Miller, MDc, Joseph E. Bavaria, MDd, Joseph S. Coselli, MDe, Michael A. Curi, MD, MPAf, Holger Eggebrecht, MDg, John A. Elefteriades, MDh, Raimund Erbel, MDi, Thomas G. Gleason, MDj, Bruce W. Lytle, MDk, R. Scott Mitchell, MDl, Christoph A. Nienaber, MDm, Eric E. Roselli, MDk, Hazim J. Safi, MDn, Richard J. Shemin, MDo, Gregorio A. Sicard, MDp, Thoralf M. Sundt, III, MDq, Wilson Y. Szeto, MDr, Grayson H. Wheatley, III, MDs

a Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
b Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri
c Department of Cardiothoracic Surgery, Stanford University Medical School, Stanford, California
d Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
e Baylor College of Medicine, Houston, Texas
f Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Maryland
g Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
h Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
i Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
j Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
k Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
l Stanford University School of Medicine, Stanford, California
m University Hospital Rostock, Division of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
n University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Texas
o Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Cardiovascular Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
p Department of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri
q Mayo Clinic, Rochester, Minnesota
r Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
s Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, Arizona

* Address correspondence to Dr Svensson, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk F24, Cleveland, OH 44195 (Email: svenssl{at}ccf.org).

Between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and continues to increase. For the thoracic aorta, these diseases are increasingly treated by stent-grafting. No prospective randomized study exists comparing stent-grafting and open surgical treatment, including for disease subgroups. Currently, one stent-graft device is approved by the Food and Drug Administration for descending thoracic aortic aneurysms although two new devices are expected to obtain FDA approval in 2008. Stent-graft devices are used "off label" or under physician Investigational Device Exemption studies for other indications such as traumatic rupture of the aorta and aortic dissection. Early first-generation devices suffered from problems such as stroke with insertion, ascending aortic dissection or aortic penetration from struts, vascular injury, graft collapse, endovascular leaks, graft material failure, continued aneurysm expansion or rupture, and migration or kinking; however, the newer iterations coming to market have been considerably improved. Although the devices have been tested in pulse duplicators out to 10 years, long-term durability is not known, particularly in young patients. The long-term consequences of repeated computed tomography scans for checking device integrity and positioning on the risk of irradiation-induced cancer remains of concern in young patients. This document (1) reviews the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts; and (2) offers suggestions for treatment.




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 J. Thorac. Cardiovasc. Surg.Home page
C. A. Anderson, E. Rodriguez, M. C. Stoner, and A. P. Kypson
Delayed type A dissection after arch transposition and stent graft therapy of a type B dissection
J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 1031 - 1032.
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 J. Thorac. Cardiovasc. Surg.Home page
A. Khoynezhad, C. E. Donayre, B. O. Omari, G. E. Kopchok, I. Walot, and R. A. White
Midterm results of endovascular treatment of complicated acute type B aortic dissection
J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 625 - 631.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. Funovics, M. Blum, H. Langenberger, C. Plank, M. Schoder, G. Edelhauser, R. Gottardi, D. Berzacky, M. Dorfmeister, M. Grimm, et al.
Endovascular Repair of the Descending Aorta and the Aortic Arch With the Relay Stent Graft
Ann. Thorac. Surg., August 1, 2009; 88(2): 637 - 640.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. L. Estrera, R. Sheinbaum, C. C. Miller, A. Azizzadeh, J.-C. Walkes, T.-Y. Lee, L. Kaiser, and H. J. Safi
Cerebrospinal Fluid Drainage During Thoracic Aortic Repair: Safety and Current Management
Ann. Thorac. Surg., July 1, 2009; 88(1): 9 - 15.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
I. Schuster, M. Dorfmeister, S. Scheuter-Mlaker, R. Gottardi, M. Hoebartner, S. Roedler, T. Dziodzio, A. Juraszek, C. Loewe, M. Funovics, et al.
Endovascular and Conventional Treatment of Thoracic Aortic Aneurysms: A Comparison of Costs
Ann. Thorac. Surg., June 1, 2009; 87(6): 1801 - 1805.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. Khoynezhad
Comparing Apples to Oranges: Endovascular Management of Complicated Acute Type B Aortic Dissection
Ann. Thorac. Surg., June 1, 2009; 87(6): 2005 - 2006.
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 Ann. Thorac. Surg.Home page
L. Svensson
Aortic Dissection Endovascular Stenting: Less Pain, Survival Gain?
Ann. Thorac. Surg., May 1, 2009; 87(5): 1332 - 1333.
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 Interact CardioVasc Thorac SurgHome page
R. M. S. Almeida, J. C. Leal, E. K. Saadi, D. M. Braile, A. S. T. Rocha, G. Volpiani, C. Centola, and A. Zago
Thoracic endovascular aortic repair - a Brazilian experience in 255 patients over a period of 112 months
Interact CardioVasc Thorac Surg, May 1, 2009; 8(5): 524 - 528.
[Abstract] [Full Text] [PDF]

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 VASC ENDOVASCULAR SURGHome page
P. H. Lin, T. T. Huynh, P. Kougias, J. Huh, S. A. LeMaire, and J. S. Coselli
Descending Thoracic Aortic Dissection: Evaluation and Management in the Era of Endovascular Technology
Vascular and Endovascular Surgery, February 1, 2009; 43(1): 5 - 24.
[Abstract] [PDF]

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 Interact CardioVasc Thorac SurgHome page
L. Bockeria and V. Arakelyan
eComment: Re: Acute onset of paraplegia after repair of abdominal aortic aneurysm in a patient with acute type B aortic dissection 30 December 2008
Interact CardioVasc Thorac Surg, February 1, 2009; 8(2): 242 - 242.
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 ESC Textbook of Cardiovascular MedicineHome page
C. A. Nienaber, I. Akin, R. Erbel, and A. Haverich
CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
N. T. Kouchoukos, P. Masetti, M. C. Mauney, M. C. Murphy, and C. F. Castner
One-Stage Repair of Extensive Chronic Aortic Dissection Using the Arch-First Technique and Bilateral Anterior Thoracotomy
Ann. Thorac. Surg., November 1, 2008; 86(5): 1502 - 1509.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. D. Parker and J. Golledge
Outcome of Endovascular Treatment of Acute Type B Aortic Dissection
Ann. Thorac. Surg., November 1, 2008; 86(5): 1707 - 1712.
[Abstract] [Full Text] [PDF]

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 RadioGraphicsHome page
M. J. Bean, P. T. Johnson, G. S. Roseborough, J. H. Black, and E. K. Fishman
Thoracic Aortic Stent-Grafts: Utility of Multidetector CT for Pre- and Postprocedure Evaluation1
RadioGraphics, November 1, 2008; 28(7): 1835 - 1851.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
E. Neri
Invited Commentary
Ann. Thorac. Surg., August 1, 2008; 86(2): 456 - 457.
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 Ann. Thorac. Surg.Home page
W. Y. Szeto, M. McGarvey, A. Pochettino, G. W. Moser, A. Hoboken, K. Cornelius, E. Y. Woo, J. P. Carpenter, R. M. Fairman, and J. E. Bavaria
Results of a New Surgical Paradigm: Endovascular Repair for Acute Complicated Type B Aortic Dissection
Ann. Thorac. Surg., July 1, 2008; 86(1): 87 - 94.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
G. C. Hughes, J. J. Nienaber, E. L. Bush, M. A. Daneshmand, and R. L. McCann
Use of custom Dacron branch grafts for "hybrid" aortic debranching during endovascular repair of thoracic and thoracoabdominal aortic aneurysms
J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 21 - 28.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
M. P. Siegenthaler, R. Celik, J. Haberstroh, P. Bajona, H. Goebel, K. Brehm, W. Euringer, and F. Beyersdorf
Thoracic endovascular stent grafting inhibits aortic growth: an experimental study
Eur J Cardiothorac Surg, July 1, 2008; 34(1): 17 - 24.
[Abstract] [Full Text] [PDF]

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 Eur J Cardiothorac SurgHome page
C. Probst, B. Esmailzadeh, W. Schiller, and K. Wilhelm
Emergent antegrade endovascular stent placement in a patient with perforated Stanford B dissection via right axillary artery
Eur J Cardiothorac Surg, June 1, 2008; 33(6): 1148 - 1149.
[Abstract] [Full Text] [PDF]


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