Document Detail


Chronic traumatic aneurysms of the descending thoracic aorta: mid-term results of endovascular repair using first and second-generation stent-grafts.
MedLine Citation:
PMID:  15019666     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
Authors:
Philippe Demers; Craig Miller; R Scott Mitchell; Stephen T Kee; R N Lynn Chagonjian; Michael D Dake
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  25     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-15     Completed Date:  2004-04-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  394-400     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, CA 94305, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aorta, Thoracic / injuries*
Aortic Aneurysm, Thoracic / radiography,  surgery*
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / methods*
Chronic Disease
Female
Humans
Length of Stay
Male
Middle Aged
Prosthesis Design
Recurrence
Reoperation
Stents*
Survival Analysis
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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