Short and midterm results with minimally invasive endovascular repair of acute and chronic thoracic aortic pathology

Objectives: Endovascular management of both acute and chronic thoracic aortic pathology has emerged as an alternative to open surgery. We reviewed our single center experience with endovascular devices for the treatment of thoracic aortic pathology. Methods: Between April 2000 and October 2007, 116 thoracic aortic stent grafts were placed to treat a variety of acute or chronic thoracic aortic lesions. Thirty-five percent of the cases were performed emergently. Sixty-five percent of the patients were male; the average age was 63.9 years (range 20-93 years). Indications for treatment were chronic degenerative aneurysms (n = 70), traumatic aortic disruption (n = 20), complicated dissection, intramural hematoma, or penetrating aortic ulcer (n = 14), pseudoaneurysm (n = 10), and Diverticulum of Kommerell (n = 2). Arch vessel revascularization (n = 32) or mesenteric debranching (n = 7) was performed in select cases. Devices used were industry-approved thoracic aortic devices (n = 80), aortic cuff extenders (n = 19), or custom made by the surgeon (n = 17). Results: The 30-day death, stroke and paraplegia/paresis rates were 5.2%, 8.6%, and 2.6%, respectively. Arterial access complications requiring immediate operative repair occurred at a rate of 11.2% (n = 13). The endoleak rate requiring repeat intervention was 6.9% (n = 8). The delayed graft infection rate was 5.2% (n = 6), with four of these cases resulting in death. The mean follow-up is 15 months (range 1-78 months). Computed tomography angiograms were performed at 1, 6, and 12 months following the index procedure, and yearly thereafter. Conclusions: Endovascular therapy for acute and chronic thoracic aortic pathology is a viable alternative to open surgery with comparable operative morbidity and mortality. Midterm results suggest that endografts are durable, but require more secondary interventions and imaging surveillance than open reconstruction.