Demers Philippe, Miller Craig, Scott Mitchell R, Kee Stephen T, Lynn Chagonjian R N, Dake Michael D
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, CA 94305, USA.
Eur J Cardiothorac Surg. 2004 Mar;25(3):394-400. doi: 10.1016/j.ejcts.2003.11.035.
Endovascular stent-graft repair holds promise for treating traumatic injuries of the descending thoracic aorta. The durability of this approach, however, remains unknown. The objective is to evaluate the mid-term results of stent-graft repair of chronic traumatic aneurysms of the descending thoracic aorta.
Between 1993 and 2000, endovascular repair of the descending thoracic aorta with first (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 15 patients (mean age 54+/-13 years) at an average of 18+/-14 years after the injury. Because of comorbidities, 4 patients (27%) were judged not to be reasonable surgical candidates for conventional open surgical approach. Follow-up was 100% complete and averaged 55+/-29 months.
Stent-graft deployment was successful in all without need for surgical conversion. One patient died early postoperatively. No neurologic complications occurred. Two patients had a primary endoleak, one of them was successfully treated before discharge. Actuarial survival estimates at 1 and 6 years were 93+/-6% and 85+/-10%. Actuarial freedom from reintervention on the descending thoracic aorta was 93+/-6% and 70+/-15% at 1 and 6 years, respectively. Actuarial freedom from treatment failure (a conservative, all-encompassing performance indicator including endoleak, device mechanical fault, reintervention, late aortic-related death, or sudden, unexplained late death) at 1 and 6 years was 87+/-8% and 51+/-15%.
Stent-grafting is safe in selected patients with chronic traumatic aneurysms and associated with satisfactory-but not optimal-mid-term durability. Serial follow-up surveillance imaging is mandatory to detect late stent-graft complications. Younger, good risk patients should be offered conventional open operation, reserving stent-grafting for those who are at prohibitive operative risk or who have limited life expectancy.
