ENDOVASCULAR STENT GRAFT REPAIR FOR ANEURYSMS ON THE DESCENDING THORACIC AORTA

Background. The traditional treatment of aneurysms of the descending t horacic aorta includes posterolateral thoracotomy and aortic replaceme nt with a prosthetic graft. In this study, we report our experiences a nd 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 co nventional surgical treatment. All of these patients were suitable can didates for endovascular stenting; however, no stent graft material wa s available at the time of operation. Ten patients (1 chronic dissecti on, 9 atherosclerotic aneurysm) received in the past 8 months the firs t commercially manufactured endovascular stent graft. The mean diamete r of the aneurysms in this group was 7 cm (range, 6 to 8 cm). Two sten t patients were operated on using only spinal cord analgesia. All sten t grafts were custom designed for each of the 10 patients. Results. Th e 30-day mortality in the conventional group was 31% versus 10% in the stent group. Mean length of intervention was 320 minutes in the conve ntional group versus 150 minutes in the endovascular group. Spinal cor d injury occurred in 5 patients (12%) in the surgical group, whereas n one of the stented patients developed any neurologic sequelae. Mean in tensive 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 we re deployed in 5 patients of our series. Five patients required transp osition 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 patient s (80%). Two patients required restenting as a result of leakage (20%) . Stent graft placing was performed through the femoral artery in 8 pa tients, whereas access was only achieved through the abdominal aorta i n 2 patients. Conclusions. These preliminary results demonstrate that endovascular stent graft replacement might be a promising, cheaper, an d safe alternative method in selected patients with descending thoraci c aneurysms. (Ann Thorac Surg 1998;66:19-25) (C) 1998 by The Society o f Thoracic Surgeons.