HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Himanshu J. Patel G. Michael Deeb Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Patel, H. J. Articles by Deeb, G. M. Search for Related Content PubMed Articles by Patel, H. J. Articles by Deeb, G. M. Related Collections Great vessels

---

Original Articles: Adult Cardiac

Late Outcomes of Endovascular Aortic Repair for the Infected Thoracic Aorta

^a Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Michigan
^b Department of Radiology, University of Michigan Cardiovascular Center, Ann Arbor, Michigan

Accepted for publication February 9, 2009.

^_* Address correspondence to Dr Patel, Department of Surgery, Section of Cardiac Surgery, 5144 Cardiovascular Center, 1500 E Medical Center Dr SPC 5864, Ann Arbor, MI 48109-5864 (Email: hjpatel{at}med.umich.edu).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: Untreated infectious thoracic aortic pathology (ITAP) has a dismal prognosis. Despite its high rates of morbidity in this setting, conventional open repair remains the gold standard therapy. Understanding the limitations of open repair, we describe outcomes for one of the largest series of ITAP treated with thoracic endovascular repair.

Methods: Of 170 patients undergoing thoracic endovascular repair (1993 to 2008), 20 presenting with ITAP were identified. Indications for intervention included aortobronchial (n = 10), aortoesophageal (n = 2), or aortocutaneous fistulae (n = 1), or mycotic aneurysms (n = 7). Underlying disease included fusiform aneurysm (n = 1), saccular aneurysm or pseudoaneurysm (n = 18), or dissection (n = 1). Four patients had ITAP from infected grafts. Follow-up was 100% complete (mean, 28.6 months).

Results: Median age was 73 years. A history of immunosuppression was present in 4; concurrent malignancy was present in 5. Arch repair was needed in 8; total descending, in 6. Three patients underwent hybrid thoracic endovascular repair or debranching procedures. Causes of in-hospital mortality (n = 3; 15.0%) included refractory hypoxemia (n = 1) and sepsis from tracheoesophageal fistula (n = 1) or pneumonia (n = 1). Dialysis was needed in 2; none sustained postoperative stroke or paraplegia. Mean Kaplan-Meier survival was 39.0 months. Late mortality was seen in 13 patients, with 3 attributed to recurrent ITAP. There was a trend for recurrence of ITAP when thoracic endovascular repair was originally performed in an infected graft (p = 0.08). At last imaging follow-up, 14 patients had a healed aorta.

Conclusions: Treatment with thoracic endovascular repair for ITAP can be accomplished with acceptable results. Late mortality is frequently related to underlying comorbidities, rather than complications from the aortic disease itself, suggesting that thoracic endovascular repair is an appropriate palliative therapeutic option in this high-risk cohort.