Document Detail

Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers.
MedLine Citation:
PMID:  18829235     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To present early and midterm results after endovascular stent graft repair of patients with penetrating aortic ulcers (PAU).
METHODS: Between January 1997 and March 2008, a total of 202 patients received thoracic aortic endografting in our institution, 48 patients (32 men, median age 70 years, range, 48-89) with PAU. A retrospective analysis of these patients was performed. Thirty-one patients (65%) showed an acute aortic syndrome (8 contained rupture, 23 symptomatic). Follow-up scheme included postoperative computed tomography angiography prior to discharge, at 3, 6, and 12 months, and yearly thereafter. Mean follow-up was 31.3 months (1.3-112.6).
RESULTS: Technical success was achieved in 93.7%. Primary clinical success rate was 81.2%. In-hospital mortality was 14.6%. Perioperative mortality was significantly (P = .036) higher in patients with acute aortic syndrome compared to asymptomatic patients (22.5% vs 0%). Postoperative complications occurred in 15 patients (31%), including 2 patients with minor strokes and 6, respectively, 5 patients with cardiac and/or respiratory complications. Early endoleaks were observed in 9 patients (19%), late endoleaks in another 2 patients. Reintervention was necessary in 4 out of 48 patients (8.4%). The actuarial survival estimates at 1, 3, and 5 years were 78% +/- 6%, 74% +/- 7%, and 61% +/- 10%, respectively. There was no aortic-related death during follow-up. Cox regression showed age (hazard ratio [HR]; 1.08, P = .036) and a maximum aortic diameter >50 mm (HR, 4.92; P = .021) as independent predictors of death.
CONCLUSION: Endovascular treatment of penetrating aortic ulcers is associated with a relevant morbidity and mortality rate in frequently highly comorbid patients. Midterm results could prove a sustained treatment success regarding actuarial survival and aortic-related death. Emergencies show a significantly worse outcome, but treatment is still warranted in these symptomatic patients.
Philipp Geisbüsch; Drosos Kotelis; Tim F Weber; Alexander Hyhlik-Dürr; Hans-Ulrich Kauczor; Dittmar Böckler
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-10-01
Journal Detail:
Title:  Journal of vascular surgery     Volume:  48     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2009-01-02     Completed Date:  2009-01-22     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1361-8     Citation Subset:  IM    
Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany.
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MeSH Terms
Aged, 80 and over
Angioscopy / methods*
Aorta, Thoracic*
Aortic Diseases / diagnosis,  surgery*
Blood Vessel Prosthesis*
Follow-Up Studies
Magnetic Resonance Angiography
Middle Aged
Retrospective Studies
Rupture, Spontaneous
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Ulcer / diagnosis,  surgery*

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