Self-expanding endovascular stent-graft implant for treatment of descending aortic diseases

Background: Aneurysms and dissections involving the descending thoracic aor ta and the distal portion of the aortic arch are difficult to resolve surgi cally. The introduction of endovascular self-expanding stent-grafts has sim plified the operation. Given the complications associated with their periph eral placement, we explored the feasibility of surgical insertion. Methods: Thirteen patients underwent surgical insertion of a stent-graft into the a ortic arch via longitudinal aortotomy. Six patients had aneurysms (ruptured in two, and seven dissections (acute in two, ruptured in one). Five patien ts also underwent associated procedures including aortic valve replacement tone), ascending aorta replacement (two), arch replacement (one), and coron ary artery bypass (one). Results: There was one intraoperative death due to ascending aortic dissection, and two hospital deaths due to multiple compl ications. Of ten patients discharged, one died 3 months postoperatively. Th e remaining survivors are well, and imaging studies confirmed adequate corr ection of the aortic disease. Conclusions: The use of this technique simpli fies the operation and treatment of particular cases of aortic disease. The observed morbidity and mortality are due to factors independent of the tec hnique.