Print this pageStent Graft Repair Of the Thoracic Aorta: Midterm Results
David H Stone, Mark F Conrad, David C Brewster, Christopher J Kwolek, Glenn M LaMuraglia, Michael T Watkins, Richard P Cambria
Massachusetts General Hospital, Boston, MA
Introduction and Objectives:
Pivotal and comparative(to open repair) trial data are emerging for stent graft repair(SG) of the thoracic aorta. With the advent of FDA approved devices, we reviewed procedure-related perioperative morbidity, mortality, and midterm outcomes in a contemporary series of patients treated with SG of the thoracic aorta.
Methods:
A review of patients undergoing SG procedures from 1/1/1996-3/31/2005 was performed from a prospectively compiled database. Perioperative and late survival as well as late results were assessed by Kaplan-Meier life-table and Chi-squared analysis.
Results:
Eighty-one patients(mean age 69.2yrs, 49(60.5%) male) underwent SG for a variety of thoracic aortic pathology(50(61.7%) degenerative aneurysms, 12(14.8%) penetrating ulcers, 13(16%) pseudoaneurysms, 5(6.1%) traumatic tears, and 1(1.2%) acute dissection), with a mean follow-up of 25 months(range 0-104). 13.6% patients(n=11) presented acutely, while 86.4%(n=70) were non-urgent. There were no statistical differences in periprocedural mortality or long-term survival between groups. Technical success of implantation was 90%. 17.2%(n=14) experienced access site complications and 28.4%(n=23) of patients required iliac graft conduits for successful access. Device distribution included 61 commercially manufactured devices and 20 custom-made stent grafts(early experience). Perioperative mortality(<30 days) was 8.9%, while survival at 54 months was 65.9±6.6%. Periprocedural mortality and survival were not statistically affected by aortic pathology or device type. The incidence of paraplegia/paraparesis was 4.9%(n=4) and was not statistically related to aortic segment length covered(mean 28.7cm) or previous AAA repair(n=30). Freedom from device related complications(endoleak, graft migration) at 54 months was 80±7.3% and was statistically unrelated to aortic pathology or device type. One patient required graft explantation because of infection.
Conclusions:
Good clinical results can be achieved in the majority of SG patients, with highly satisfactory long-term survival. Arterial access issues remain an important technical consideration. Midterm results suggest that SG will be an effective alternative for patients with a variety of challenging TA pathology.