Stent-graft repair of thoracic aortic aneurysms

R. S. Mitchell, D. C. Miller, M. D. Dake

Research output: Contribution to journalReview article

86 Scopus citations

Abstract

Aneurysmal disease of the thoracic aorta continues to be a very challenging management problem for physicians because of the many comorbidities harbored by these patients, as well as the morbidity of the conventional open repair via left thoracotomy. In a combined effort between interventional radiology and cardiovascular surgery, an endovascular stent graft repair has been devised for these patients in an effort to reduce morbidity. This report documents the results in the first 108 patients so treated. The graft itself, custom-made for each individual, is composed of interlocked, self-expanding 'Z' stents covered with a woven Dacron graft. Compressed in a loading capsule, the graft can then be advanced through a 27- French (outside diameter; OD) sheath, which is positioned within the aneurysm under fluoroscopic guidance. Relatively normal 2- to 3-cm segments of proximal and distal aorta allow an adequate friction seal to prevent stent graft dislodgement and also provide a hemostatic seal to obliterate aneurysm filling. Complete aneurysm thrombosis was achieved primarily in 103 patients. There were 10 deaths (9.25%) within the first 30 days, four of which were directly attributable to the stent graft procedure. Perioperative strokes occurred in four patients, and there were four instances of paraplegia. There have been two documented stent graft failures in a mean follow-up of 21.8 months (range, 1 to 57 months). Although the long-term durability of this procedure remains unknown, we believe this less invasive endovascular approach will prove to be an effective and less morbid treatment for aneurysmal disease of the descending thoracic aorta.

Original languageEnglish (US)
Pages (from-to)257-271
Number of pages15
JournalSeminars in Vascular Surgery
Volume10
Issue number4
Publication statusPublished - Dec 1 1997
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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