Placement of Endovascular Stent-Grafts for Emergency Treatment of Acute Disease of the Descending Thoracic Aorta

• Published in: American journal of roentgenology (1976) Vol. 179; no. 2; pp. 337 - 345
• Main Authors: Czermak, Benedikt V, Waldenberger, Peter, Perkmann, Reinhold, Rieger, Michael, Steingruber, Iris E, Mallouhi, Ammar, Fraedrich, Gustav, Jaschke, Werner R
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.08.2002; American Roentgen Ray Society
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - surgery; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm - surgery; Aortic Diseases - diagnostic imaging; Aortic Diseases - surgery; Aortic Rupture - surgery; Arteriosclerosis - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Diseases of the aorta; Emergencies; Female; Humans; Male; Medical sciences; Middle Aged; Radiography; Stents; Ulcer - surgery; Human; Penetrant; Acute; Treatment efficiency; Laying process; Instrumentation therapy; Cardiovascular disease; Endovascular route; Stent; Vascular disease; Dissecting aneurysm; Thoracic aorta; Case study; Follow up study; Atherosclerosis; Tissue rupture; Aorta; Graft; Ulcer; Feasibility; Safety; Aortic disease
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.179.2.1790337

The aim of this study was to evaluate the feasibility, safety, and effectiveness of endovascular stent-graft placement for the emergency treatment of acute descending thoracic aortic disease. From January 1996 through November 2001, 18 patients underwent emergency endovascular stent-graft placement for various types of acute descending thoracic aortic disease. Five patients had Stanford type B aortic dissection, six had traumatic ruptures of the thoracic aorta, five had ruptured aortic aneurysms, and two had penetrating atherosclerotic aortic ulcers. All patients presented with life-threatening symptoms requiring treatment with stent-grafts from the emergency kit. All were at high surgical risk due to serious comorbidities. The efficacy of the procedure was assessed at follow-up studies before discharge and at 3, 6, and 12 months after intervention and yearly thereafter. The primary technical success rate was 78%. Four patients had primary perigraft leaks. The secondary technical success rate was 83%. One patient died 20 hr after intervention from stent-graft-related causes. Follow-up studies revealed stent-graft migration in one patient. Progression of disease was observed in one patient treated for dissection and in both patients treated for penetrating ulcers. One patient died 7 months after intervention of unknown reasons; all other patients are alive. The mean follow-up time was 17.4 months (range, 0-38 months). Emergency repair of acute descending thoracic aortic disease with stent-graft placement can be successfully accomplished and may be a promising alternative to open-chest surgery, especially in patients at high risk.