Thoracic aortic aneurysms: Treatment with endovascular self-expandable stent grafts

Background. This study was performed to evaluate the safety and feasibility of endovascular stent graft placement in the treatment of descending thora cic aortic aneurysms. Methods. Between November 1996 and February 1999, endovascular stent graft repair was used in 21 patients. There were 5 women and 16 men with a mean a ge of 67 years (range, 41 to 87 years). An atherosclerotic aneurysm with a diameter of more than 6 cm was the indication for intervention in 19 patien ts (90.5%). In 2 patients (9.5%), a localized aortic dissection with a diam eter of more than 6 cm was treated. In 71.4% (15 of 21) of patients, multip le stents were necessary for aneurysm exclusion. To allow safe deployment o f the stent graft, preliminary subclavian-carotid artery transposition was performed in 9 patients (42.9%). Vascular access was achieved through a sma ll incision in the abdominal aorta (n = 6), an iliac artery (n = 8), or a f emoral artery (n = 7). Talent and Prograft stent grafts were used. Results. Successful deployment of the endovascular stent grafts was achieve d in all patients. Two patients died postoperatively (mortality rate, 9.5%) , 1 of aneurysmal rupture and the other of impaired perfusion of the celiac axis. Repeat stenting was done in 3 patients because of intraoperative lea kage. Conclusions. Endovascular stent graft repair is a promising and less invasi ve alternative to exclude the aneurysm from blood flow. This technique allo ws treatment of patients who are unsuitable for conventional surgical proce dures. An exact definition of inclusion criteria and technical development of stent grafts should contribute to further improvements in clinical resul ts. (C) 2000 by The Society of Thoracic Surgeons.