Mestres Gaspar, Rodríguez Rubén, García-Madrid Cesar, Montañà Xavier, Burrel Marta, Cruz Luis Fernando, Flores Carlos, Riambau Vicente
Sección de Cirugía Vascular, Servicio de Cirugía Cardiovascular, Instituto Clínico del Tórax, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
Rev Esp Cardiol (Engl Ed). 2012 Jan;65(1):54-9. doi: 10.1016/j.recesp.2011.07.020. Epub 2011 Oct 24.
The aim of this work is to describe the short- and mid-term results of endovascular treatment of penetrating ulcers in the thoracic aorta.
Between 1998 and 2010, 22 patients with penetrating ulcers in the thoracic aorta received endografts (mean age 69.8 years, 91% male); 50% were indicated for acute aortic syndrome (8 chest pain, 1 aortic rupture, 1 aortobronchial fistula, 1 distal embolization) and 50% for aortic or ulcer diameter. All preoperative, operative and follow-up data were recorded prospectively and met EUROSTAR criteria.
Technical success was 100% with no intraoperative deaths or open conversions; 6 (27.3%) required preoperative supraaortic trunk debranching and 1.3 endografts were used per patient; 27.3% developed complications in-hospital and 9.1% required reintervention prior to discharge. Mortality at 30 days was 4.5%. After a mean 52.3 month follow-up (range 0.1-122), cumulative survival free from complications and reinterventions at 100 months was 61.7% and 79.5% respectively, with 95.5% cumulative survival free from aorta- or procedure-related death. We identified no factors significantly related to poor intra- or postoperative clinical course.
Endovascular treatment of penetrating aortic ulcers is both possible and effective despite high patient comorbidity. Although a substantial rate of complications and reinterventions can be expected-especially in-hospital-(38.3% and 20.5% respectively at 100 months), long-term mortality is low (4.5%).
