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Title: Mid-Term Results After Endovascular Stent-Grafting of Descending Aortic Aneurysms in High-Risk Patients

Abstract

Purpose. To analyze our experience with endovascular stent-grafting of descending aortic aneurysms in high-risk patients. Methods. Nineteen patients underwent endovascular stent-graft repair of descending aortic aneurysms using the Talent Stent Graft System (Medtronic). All patients were considered high-risk for open surgical repair due to their age, requirement for emergency surgery, and comorbidities. Computed tomography and/or MR tomography were performed at 3, 6 and 12 months postoperatively and thereafter every 12 months. Results. Secondary technical success was 100%. Thirty-day mortality was 5%. Incidence of postoperative stroke and paraplegia were 5% each. One patient required a second stent-graft due to a type I endoleak during the same hospital stay (primary technical success 95%). All patients have been followed for a median of 20 months. No migration, wire fractures or endoleak appeared during follow-up. Conclusion. Endovascular stent-grafting had a low 30-day mortality and morbidity in high-risk patients. One patient developed an aortoesophageal fistula 40 days after stent implantation. Stent-graft repair is a valuable supplement to surgical therapy in high-risk patients.

Authors:
;  [1];  [2];  [1];  [2];  [1];  [2]
  1. University Hospital Schleswig-Holstein, Department of Cardiovascular Surgery (Germany)
  2. University Hospital Schleswig-Holstein, Department of Diagnostic Radiology (Germany)
Publication Date:
OSTI Identifier:
21091158
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 29; Journal Issue: 5; Other Information: DOI: 10.1007/s00270-004-0183-5; Copyright (c) 2006 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BONE FRACTURES; COMPUTERIZED TOMOGRAPHY; GRAFTS; MORTALITY; PATIENTS; REPAIR; SURGERY; THERAPY

Citation Formats

Brandt, Michael, E-mail: mbrandt@kielheart.uni-kiel.de, Walluscheck, Knut P., Jahnke, Thomas, Attmann, Tim, Heller, Martin, Cremer, Jochen, and Mueller-Huelsbeck, Stefan. Mid-Term Results After Endovascular Stent-Grafting of Descending Aortic Aneurysms in High-Risk Patients. United States: N. p., 2006. Web. doi:10.1007/S00270-004-0183-5.
Brandt, Michael, E-mail: mbrandt@kielheart.uni-kiel.de, Walluscheck, Knut P., Jahnke, Thomas, Attmann, Tim, Heller, Martin, Cremer, Jochen, & Mueller-Huelsbeck, Stefan. Mid-Term Results After Endovascular Stent-Grafting of Descending Aortic Aneurysms in High-Risk Patients. United States. doi:10.1007/S00270-004-0183-5.
Brandt, Michael, E-mail: mbrandt@kielheart.uni-kiel.de, Walluscheck, Knut P., Jahnke, Thomas, Attmann, Tim, Heller, Martin, Cremer, Jochen, and Mueller-Huelsbeck, Stefan. 2006. "Mid-Term Results After Endovascular Stent-Grafting of Descending Aortic Aneurysms in High-Risk Patients". United States. doi:10.1007/S00270-004-0183-5.
@article{osti_21091158,
title = {Mid-Term Results After Endovascular Stent-Grafting of Descending Aortic Aneurysms in High-Risk Patients},
author = {Brandt, Michael, E-mail: mbrandt@kielheart.uni-kiel.de and Walluscheck, Knut P. and Jahnke, Thomas and Attmann, Tim and Heller, Martin and Cremer, Jochen and Mueller-Huelsbeck, Stefan},
abstractNote = {Purpose. To analyze our experience with endovascular stent-grafting of descending aortic aneurysms in high-risk patients. Methods. Nineteen patients underwent endovascular stent-graft repair of descending aortic aneurysms using the Talent Stent Graft System (Medtronic). All patients were considered high-risk for open surgical repair due to their age, requirement for emergency surgery, and comorbidities. Computed tomography and/or MR tomography were performed at 3, 6 and 12 months postoperatively and thereafter every 12 months. Results. Secondary technical success was 100%. Thirty-day mortality was 5%. Incidence of postoperative stroke and paraplegia were 5% each. One patient required a second stent-graft due to a type I endoleak during the same hospital stay (primary technical success 95%). All patients have been followed for a median of 20 months. No migration, wire fractures or endoleak appeared during follow-up. Conclusion. Endovascular stent-grafting had a low 30-day mortality and morbidity in high-risk patients. One patient developed an aortoesophageal fistula 40 days after stent implantation. Stent-graft repair is a valuable supplement to surgical therapy in high-risk patients.},
doi = {10.1007/S00270-004-0183-5},
journal = {Cardiovascular and Interventional Radiology},
number = 5,
volume = 29,
place = {United States},
year = 2006,
month =
}
  • Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endograftsmore » were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising.« less
  • Endovascular repair of thoracic aortic aneurysms is emerging as an attractive alternative to surgical graft replacement. However,patients with aortic arch aneurysms are often excluded from the target of endovascular repair because of lack of suitable landing zones, especially at the proximal ones. In this paper we describe our method for treating patients with aortic arch aneurysms using a combination of extra anatomical bypass surgery and endovascular stent-grafting.
  • Purpose: To investigate pressure and maximum rate of rise of systolic pressure (peak dP/dt) in completely excluded aneurysms and endoleaks to determine the hemodynamic impact of endoleaks. Methods: In mongrel dogs (n =36) experimental aneurysms were created by insertion of a patch (portion of rectus abdomen is muscle sheath) into the infrarenalaorta. In group I (n 18), all aortic branches of the aneurysm were ligated and all aneurysms were completely excluded by stent grafts. Group II (n = 18) consisted of aneurysms with patent aortic side branches that represented sources of endoleaks.One week (n = 12), six weeks (n =more » 12),and six months (n = 12) after stent grafting,hemodynamic measurements were obtained in thrombosed aneurysms and proved endoleaks. Systemic blood pressure and intraaneurysmal pressure were simultaneously measured and the respective peak dP/dt were computed. Results: At the six-month follow-up, the systolic-pressure ratio (intraaneurysmatic pressure: systemic pressure)was significantly increased in endoleaks compared to non-perfused areas(0.879 {+-} 0.042 versus 0.438 {+-} 0.176, p <0.01, group II) or completely excluded aneurysms (0.385 {+-}0.221, group I). Peak dP/dt ratio (intraaneurysmal peak dP/dt: systemic peak dP/dt) was 0.922 {+-} 0.154 in endoleaks, compared to 0.084 {+-} 0.080 in non-perfused areas (group II, p <0.01), and was 0.146 {+-} 0.121 in completely excluded aneurysms (group I). The diastolic-pressure ratio was also increased inendoleaks compared to non-perfused areas (0.929 {+-} 0.088 versus 0.655 {+-} 0.231, p < 0.01, group II) or completely excluded aneurysms (0.641 {+-} 0.278, group I). In excluded aneurysms, pressure exposure declined as the length of the follow-up period increased. Conclusion: Type II endoleaks transmit pulsatile pressure of near systemic level and indicate insufficient treatment result. In contrast, complete endovascular exclusion of aneurysms results in significantly reduced pressure exposure.« less
  • Bronchial artery dilatation and aneurysm formation is a potential complication of local inflammation, especially in bronchiectasis. When the bronchial artery has an ectopic origin from the inferior segment of the aortic arch, aneurysms may mimick aortic aneurysms. Despite this particular location, endovascular treatment is possible. We report two such aneurysms that were successfully embolized with steel coils.
  • The endovascular repair of abdominal aorticaneurysm (AAA) with stent grafts is rapidly becoming an important alternative to open repair. Suprarenal stent grafting, recently modified from conventional infrarenal stent grafting, is a technique for the purpose of treating patients with inappropriate aneurysm necks.Unlike open repair, the success of endoluminal repair cannot be ascertained by means of direct examination and thus relies on imaging results. The use of conventional angiography for arterial imaging has become less dominant, while helical computed tomography angiography(CTA) has become the imaging modality of choice for both preoperative assessment and postoperative followup after treatment with stent graft implants.more » There is an increasing likelihood that radiologists will become more and more involved in the procedure of aortic stent grafting and in giving the radiological report on these patients treated with stent grafts. It is necessary for radiologists to be familiar with the imaging findings, including common and uncommon appearances following aortic stent grafting. The purpose of this pictorial essay is to describe and present normal and abnormal imaging appearances following aortic stent grafting based on helical CTA.« less