Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: Mid-term results

Philippe Demers, D. Craig Miller, R. Scott Mitchell, Stephen T. Kee, Lynn Chagonjian, Michael D. Dake

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background. Localized aortic pathoanatomic abnormalities are good targets for endovascular stent-grafting but only short-term results have been reported. Our objective was to determine the effectiveness of endovascular stent-graft treatment of patients with descending thoracic atherosclerotic penetrating atherosclerotic ulcers (PAU) and to identify risk factors for treatment failure. Methods. Between 1993 and 2000 endovascular repair of PAU with first-generation (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 26 patients (mean age, 70 years), 6 (23%) of whom had rupture. Fourteen patients (54%) were not candidates for open surgical repair. Follow-up was 100% complete (average, 51 months; maximum, 114 months). Outcome variables considered in the multivariable analysis included death and treatment failure (composite end-point comprising early death, endoleak, stent-graft mechanical fault, late aortic event, reintervention, and aortic-related or sudden death). Results. Three patients (12% ± 7% [±70% confidence limits]) died within 30 days and 2 had an early type I endoleak. Primary success rate was 92%. Actuarial survival estimates at 1, 3, and 5 years were 85% ± 8%, 76% ± 8% and 70% ± 10% respectively and actuarial freedom from treatment failure was 81% ± 8%, 71% ± 9% and 65% ± 10%. Multivariable analyses identified previous cerebrovascular accident (hazard ratio [HR] 17.1, p = 0.02) and female sex (HR 7.4, p = 0.08) as independent risk factors for death. For treatment failure the predictors were increasing aortic diameter (HR 1.1 [per mm above the mean value], p = 0.01) and female sex (HR 5.5, p = 0.09). Conclusions. Endovascular stent-graft repair is effective but not curative treatment for selected, high surgical risk, elderly patients with a descending aortic PAU over the medium term. Assiduous serial follow-up imaging after stent-grafting is mandatory to detect late complications especially in those with a large aorta.

Original languageEnglish (US)
Pages (from-to)81-86
Number of pages6
JournalAnnals of Thoracic Surgery
Volume77
Issue number1
DOIs
StatePublished - Jan 2004
Externally publishedYes

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Thoracic Aorta
Ulcer
Stents
Treatment Failure
Transplants
Endoleak
Sex Ratio
Sudden Death
Aorta
Rupture
Thorax
Stroke
Survival
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta : Mid-term results. / Demers, Philippe; Miller, D. Craig; Mitchell, R. Scott; Kee, Stephen T.; Chagonjian, Lynn; Dake, Michael D.

In: Annals of Thoracic Surgery, Vol. 77, No. 1, 01.2004, p. 81-86.

Research output: Contribution to journalArticle

Demers, Philippe ; Miller, D. Craig ; Mitchell, R. Scott ; Kee, Stephen T. ; Chagonjian, Lynn ; Dake, Michael D. / Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta : Mid-term results. In: Annals of Thoracic Surgery. 2004 ; Vol. 77, No. 1. pp. 81-86.
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abstract = "Background. Localized aortic pathoanatomic abnormalities are good targets for endovascular stent-grafting but only short-term results have been reported. Our objective was to determine the effectiveness of endovascular stent-graft treatment of patients with descending thoracic atherosclerotic penetrating atherosclerotic ulcers (PAU) and to identify risk factors for treatment failure. Methods. Between 1993 and 2000 endovascular repair of PAU with first-generation (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 26 patients (mean age, 70 years), 6 (23{\%}) of whom had rupture. Fourteen patients (54{\%}) were not candidates for open surgical repair. Follow-up was 100{\%} complete (average, 51 months; maximum, 114 months). Outcome variables considered in the multivariable analysis included death and treatment failure (composite end-point comprising early death, endoleak, stent-graft mechanical fault, late aortic event, reintervention, and aortic-related or sudden death). Results. Three patients (12{\%} ± 7{\%} [±70{\%} confidence limits]) died within 30 days and 2 had an early type I endoleak. Primary success rate was 92{\%}. Actuarial survival estimates at 1, 3, and 5 years were 85{\%} ± 8{\%}, 76{\%} ± 8{\%} and 70{\%} ± 10{\%} respectively and actuarial freedom from treatment failure was 81{\%} ± 8{\%}, 71{\%} ± 9{\%} and 65{\%} ± 10{\%}. Multivariable analyses identified previous cerebrovascular accident (hazard ratio [HR] 17.1, p = 0.02) and female sex (HR 7.4, p = 0.08) as independent risk factors for death. For treatment failure the predictors were increasing aortic diameter (HR 1.1 [per mm above the mean value], p = 0.01) and female sex (HR 5.5, p = 0.09). Conclusions. Endovascular stent-graft repair is effective but not curative treatment for selected, high surgical risk, elderly patients with a descending aortic PAU over the medium term. Assiduous serial follow-up imaging after stent-grafting is mandatory to detect late complications especially in those with a large aorta.",
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T1 - Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta

T2 - Mid-term results

AU - Demers, Philippe

AU - Miller, D. Craig

AU - Mitchell, R. Scott

AU - Kee, Stephen T.

AU - Chagonjian, Lynn

AU - Dake, Michael D.

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N2 - Background. Localized aortic pathoanatomic abnormalities are good targets for endovascular stent-grafting but only short-term results have been reported. Our objective was to determine the effectiveness of endovascular stent-graft treatment of patients with descending thoracic atherosclerotic penetrating atherosclerotic ulcers (PAU) and to identify risk factors for treatment failure. Methods. Between 1993 and 2000 endovascular repair of PAU with first-generation (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 26 patients (mean age, 70 years), 6 (23%) of whom had rupture. Fourteen patients (54%) were not candidates for open surgical repair. Follow-up was 100% complete (average, 51 months; maximum, 114 months). Outcome variables considered in the multivariable analysis included death and treatment failure (composite end-point comprising early death, endoleak, stent-graft mechanical fault, late aortic event, reintervention, and aortic-related or sudden death). Results. Three patients (12% ± 7% [±70% confidence limits]) died within 30 days and 2 had an early type I endoleak. Primary success rate was 92%. Actuarial survival estimates at 1, 3, and 5 years were 85% ± 8%, 76% ± 8% and 70% ± 10% respectively and actuarial freedom from treatment failure was 81% ± 8%, 71% ± 9% and 65% ± 10%. Multivariable analyses identified previous cerebrovascular accident (hazard ratio [HR] 17.1, p = 0.02) and female sex (HR 7.4, p = 0.08) as independent risk factors for death. For treatment failure the predictors were increasing aortic diameter (HR 1.1 [per mm above the mean value], p = 0.01) and female sex (HR 5.5, p = 0.09). Conclusions. Endovascular stent-graft repair is effective but not curative treatment for selected, high surgical risk, elderly patients with a descending aortic PAU over the medium term. Assiduous serial follow-up imaging after stent-grafting is mandatory to detect late complications especially in those with a large aorta.

AB - Background. Localized aortic pathoanatomic abnormalities are good targets for endovascular stent-grafting but only short-term results have been reported. Our objective was to determine the effectiveness of endovascular stent-graft treatment of patients with descending thoracic atherosclerotic penetrating atherosclerotic ulcers (PAU) and to identify risk factors for treatment failure. Methods. Between 1993 and 2000 endovascular repair of PAU with first-generation (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 26 patients (mean age, 70 years), 6 (23%) of whom had rupture. Fourteen patients (54%) were not candidates for open surgical repair. Follow-up was 100% complete (average, 51 months; maximum, 114 months). Outcome variables considered in the multivariable analysis included death and treatment failure (composite end-point comprising early death, endoleak, stent-graft mechanical fault, late aortic event, reintervention, and aortic-related or sudden death). Results. Three patients (12% ± 7% [±70% confidence limits]) died within 30 days and 2 had an early type I endoleak. Primary success rate was 92%. Actuarial survival estimates at 1, 3, and 5 years were 85% ± 8%, 76% ± 8% and 70% ± 10% respectively and actuarial freedom from treatment failure was 81% ± 8%, 71% ± 9% and 65% ± 10%. Multivariable analyses identified previous cerebrovascular accident (hazard ratio [HR] 17.1, p = 0.02) and female sex (HR 7.4, p = 0.08) as independent risk factors for death. For treatment failure the predictors were increasing aortic diameter (HR 1.1 [per mm above the mean value], p = 0.01) and female sex (HR 5.5, p = 0.09). Conclusions. Endovascular stent-graft repair is effective but not curative treatment for selected, high surgical risk, elderly patients with a descending aortic PAU over the medium term. Assiduous serial follow-up imaging after stent-grafting is mandatory to detect late complications especially in those with a large aorta.

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