Interv Akut Kardiol. 2011;10(4):154-162

Endovascular treatment of the thoracic aorta emergencies: long term follow-up

Jan Raupach¹, Jan Vojáček², Miroslav Lojík¹, Antonín Krajina¹, Josef Bis⁴, Vendelín Chovanec¹, Jan Harrer², Martin Tuna², Radovan Malý⁴

¹ Radiologická klinika, FN a LF UK, Hradec Králové

² Kardiochirurgická klinika, FN a LF UK, Hradec Králové

³ Chirurgická klinika, FN a LF UK, Hradec Králové

⁴ I. interní klinika, FN a LF UK, Hradec Králové

Purpose: Retrospective analysis of efficacy and safety of endovascular treatment of diseases of the descending thoracic aorta and distal

aortic arch with thoracic stent-graft.

Material and Methods: From May 1999 to March 2011 we treated 62 patients (46 men, 16 women, mean age 59.5 years). These were symptomatic

degenerative aneurysms (n = 7), penetrating aortic ulcers (n = 7), mycotic aneurysms (n = 4), type B aortic dissections (n = 20), traumatic

aortic injuries (n = 24). For a short proximal anchoring zone in 3 patients we used a hybrid approach with surgical rerouting technique

and then stent-grafting. A total of 62 patients, we introduced 78 stentgrafts (on average 1.3 of the stent graft/patient). Preoperative diagnosis

and postoperative monitoring was performed using CT angiography. Follow-up interval was 1–138 months, mean 46.2 months.

Results: Technical success was 98.4 % in our group, 30 day mortality was 9.7 %, 1-year mortality was 14.5 % and overall mortality was 24.2 %.

Mortality in causal relationship to treatment of aortic disease was 8.1 %. Permanent stroke occurred after the treatment in one patient and

in one patient developed lower leg paraparesis. Six patients were treated in second period by reintervention with additional stent-graft

implantation (2 proximal, 4 distal extensions). In a group of 22 patients with coverage of the left subclavian artery (LSA) in two cases developed

claudication of the left upper extremity, once resolved spontaneously and one was solved by the surgery revascularization.

Conclusion: Endovascular treatment of descending thoracic aortic diseases has become first choice in our center. Intentional coverage

of the LSA in short and angulated landing zone to improve proximal stabilization of stent-graft and provides an acceptable risk of ischemia

of the left upper extremity. Hybrid procedures allow further expansion of endovascular treatment of the aortic arch involvement.

Keywords: thoracic aorta, aneurysm, dissection, aortic trauma, aortic ulcer, endovascular aortic repair, stent-graft, complications

Published: July 1, 2011  Show citation