Thoracic aortic stent grafts - Early experience from two centres using commercially available devices

Objectives: open surgical intervention for aneurysms of the distal arch and descending thoracic aorta is associated with high morbidity and mortality. Stent grafts offer an attractive alternative treatment for these aneurysms . The aim of this study was to assess the morbidity and mortality of endova scular treatment for these aneurysms with stent grafts. Design, patients and methods: a prospective observational study was perform ed of 37 consecutive patients treated from July 1997 to October 2000 (30 at Guy's and St. Thomas' and 7 at Sheffield). Indications included degenerati ve aneurysms (n = 18), false aneurysm (5), acute dissection (4), aortic tra nsection (4), aneurysm related to previous surgery for coarctation (3), chr onic dissection (2) and traumatic dissection (1). Nineteen were performed a s elective and 18 as non-elective procedures. Results: three non-elective patients died in hospital (in-hospital and 30-d ay mortality 8%) and one suffered a stroke with spontaneous full recovery. No elective patient died. One patient with a persistent proximal endoleak r equired conversion to open repair at 6 weeks. Two patients with persistent flow into the sac at 24 h spontaneously thrombosed at subsequent 3 month fo llow-up. Two further patients developed new distal endoleaks at 3 months an d required distal extension cuffs. One patient died at 28 months of aortic rupture. Serial CT scans had shown prolapse of the stent graft into the ane urysm sac and the patient died just before planned endovascular repair. No patient suffered paraplegia or renal failure. Intensive care facilities wer e only required for patients who needed them preoperatively. Conclusions: thoracic stent grafts can be performed with low morbidity and mortality. They offer a realistic alternative to open surgery. Long term fo llow up is required to assess their durability.