Document Detail


Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.
MedLine Citation:
PMID:  18083364     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and continues to increase. For the thoracic aorta, these diseases are increasingly treated by stent-grafting. No prospective randomized study exists comparing stent-grafting and open surgical treatment, including for disease subgroups. Currently, one stent-graft device is approved by the Food and Drug Administration for descending thoracic aortic aneurysms although two new devices are expected to obtain FDA approval in 2008. Stent-graft devices are used "off label" or under physician Investigational Device Exemption studies for other indications such as traumatic rupture of the aorta and aortic dissection. Early first-generation devices suffered from problems such as stroke with insertion, ascending aortic dissection or aortic penetration from struts, vascular injury, graft collapse, endovascular leaks, graft material failure, continued aneurysm expansion or rupture, and migration or kinking; however, the newer iterations coming to market have been considerably improved. Although the devices have been tested in pulse duplicators out to 10 years, long-term durability is not known, particularly in young patients. The long-term consequences of repeated computed tomography scans for checking device integrity and positioning on the risk of irradiation-induced cancer remains of concern in young patients. This document (1) reviews the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts; and (2) offers suggestions for treatment.
Authors:
Lars G Svensson; Nicholas T Kouchoukos; D Craig Miller; Joseph E Bavaria; Joseph S Coselli; Michael A Curi; Holger Eggebrecht; John A Elefteriades; Raimund Erbel; Thomas G Gleason; Bruce W Lytle; R Scott Mitchell; Christoph A Nienaber; Eric E Roselli; Hazim J Safi; Richard J Shemin; Gregorio A Sicard; Thoralf M Sundt; Wilson Y Szeto; Grayson H Wheatley;
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Publication Detail:
Type:  Consensus Development Conference; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  85     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-17     Completed Date:  2008-01-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  S1-41     Citation Subset:  AIM; IM    
Affiliation:
Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. svenssl@ccf.org
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, Dissecting / therapy
Aortic Aneurysm, Abdominal / therapy
Aortic Aneurysm, Thoracic / physiopathology,  therapy*
Blood Vessel Prosthesis*
Humans
Stents*

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


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