Endovascular repair of descending thoracic aortic aneurysms: an early experience with intermediate-term follow-up

Purpose: The purpose of this study was to report an initial experience with the endovascular repair of descending thoracic aortic aneurysm. Complicati ons and intermediate-term morphologic changes were identified with the inte nt of altering patient selection and device design. Methods: Endografts were placed into 25 patients at high-risk for conventio nal surgical repair over a 3(1)/(2)-year period. Devices were customized on the basis of preoperative imaging information. Follow-up computed tomograp hy scans were obtained at 1, 3, 6, and 12 months and yearly thereafter. Add itional interventions occurred in the setting of endoleaks, migration, and aneurysm growth. Results: The overall 30-day mortality rate was 20% (12.5% for elective case s; 33% for emergent cases). There were 3 conversions to open repair. Neurol ogic deficits developed in 3 patients; 1 insult resulted in permanent parap legia. Neurologic deficits were associated with longer endografts (P = .019 ). Three endoleaks required treatment, and 1 fatal rupture of the thoracic aneurysm treated occurred 6 months after the initial repair. Migrations wer e detected in 4 patients. The maximal aneurysm size decreased yearly by 9.1 5% (P = .01) or by 13.5% (P = .0005) if patients with endoleaks (n = 3 pati ents) were excluded. Both the proximal and distal neck dilated slightly ove r the course of followup (P = .019 and P = .001, respectively). The length of the proximal neck was a significant predictor of the risk for endoleakag e (P = .02). Conclusion: The treatment of descending thoracic aortic aneurysms with an e ndovascular approach is feasible and may, in some patients, offer the best means of therapy. Early complications were primarily related to device desi gn and patient selection. All aneurysms without endoleaks decreased in size after treatment. Late complications were associated with changing aneurysm morphologic features and device migration. The morphologic changes remain somewhat unpredictable; however, alterations in device design may result in improved fixation and more durable aneurysm exclusion.