Usefulness of transesophageal echocardiographic monitoring to improve the outcome of stent-graft treatment of thoracic aortic aneurysms

The stent-graft procedure is becoming an alternative to surgery for treatme nt of many diseases of the descending thoracic aorta. This study evaluated the role of transesophageal echocardiography (TEE), used in combination wit h fluoroscopy and angiography, in monitoring the outcome of stent-graft pla cement. Twenty-two consecutive patients were submitted to stent-graft posit ioning in the descending aorta for various pathologies (7 patients had type B aortic dissections, 6 had thoracic aneurysms, 2 had thoraco-abdominal an eurysms, and 7 had post-traumatic aortic aneurysms). Before stent-graft dep loyment, TEE changed the proximal site of stent positioning initially ident ified by angiography in 33% of patients (5 of 15) with aortic aneurysms bec ause of calcifications or atheromas that could interfere with stent adhesio n to the aortic wall and that were not seen on angiography. In 28% of patie nts (2 of 7) with aortic dissection, TEE showed the guidewire in the false lumen, allowing an immediate repositioning. After stent-graft deployment, c olor Doppler TEE showed a perigraft leak in 7 patients, whereas angiography detected a perigraft leak in only 2 patients (p = 0.02). In 4 of these pat ients, further balloon expansions resulted in resolution of the leak. In th e remaining 3 patients, additional stent-graft positioning was necessary. C onsidering the total patient cohort, TEE yielded relevant information, resu lting in procedure changes in 59% (13 of 22). In conclusion, TEE provided a dditional information with respect to angiography in all phases of stent-gr aft treatment, improving immediate outcome and reducing complications. (C) 2001 by Excerpta Medica, Inc.