Endovascular treatment of thoracic aortic pathology : Lessons learned

Introduction: Endovascular repair has emerged as a very important treatment modality in the management of thoracic aortic diseases due to its reduced invasiveness especially in patients at increased risk for open surgery. Aim of this study is to analyze the lessons learned in our experience of thoracic aortic endografting. Material and methods: From June 1999 to January 2006, 145 selected patients (121 men and 24 women with a mean age of 70 ± 9 years) with thoracic aorta disease received endovascular treatment with one of four different commercially produced stent grafts (Cook, Gore, Endomed, Medtronic). Indications for treatment included disease of the descending thoracic aorta in 92 cases, of the aortic arch in 43 cases and of the thoracoabdominal aorta in 10 cases. In 48 patients, an hybrid surgical and endovascular approach was required. Results: Primary technical success was achieved in 137/145 (94.5%) cases. One patient died intraoperatively and seven patients had a type "I a" endoleak. In-hospital complications included perioperative stroke in three patients, acute renal failure in two patients, acute respiratory failure in one. Initial clinical success was obtained in 128/145 patients (88.3%) with a mortality rate of 9/145 (6.2%). At 38 ± 16 months, mid-term clinical success was obtained in 89.5% of the followed patients. Two patients died from fatal aneurysm rupture. One type I endoleak was successfully treated with a rescue endovascular procedure, four cases of type I endoleak resolved completely without any further intervention, no new onset endoleak was discovered. One patient underwent a successful open conversion. Aneurysm expansion was observed in one patient. Conclusion: Endovascular surgery is changing the management of complex aortic disease. Synergy between endovascular and surgical procedures may provide a solution for many challenging clinical problems.