Document Detail

Midterm results for endovascular stent grafts via median sternotomy for distal aortic arch aneurysm.
MedLine Citation:
PMID:  16998699     Owner:  NLM     Status:  MEDLINE    
Dislocation or perigraft leakage is a major problem during the follow-up period for endovascular stent graft (EVG) implantation via median sternotomy for distal aortic arch aneurysm. Anchoring sutures have been applied for the prevention of these complications. Here, we evaluate the midterm results and the efficacy of anchoring sutures. There were 21 male and 2 female patients enrolled in the study with an average age of 70 years (59-83). Aneurysm types were 21 true aneurysms (13 fusiform, 8 saccular), 1 chronic dissection, and 1 penetrating aortic ulcer. Total arch replacement was performed in two patients and aortocoronary bypass grafting was combined in four patients. Anchoring sutures to fix the EVG via median sternotomy were applied for 11 recent patients. The average follow-up period was 44 (22-79) months. There were no operative mortalities, but one case of paraplegia, one of stroke, and two of temporary spinal cord dysfunction. Complications related to EVG via median sternotomy occurred in five patients who had not received anchoring sutures, but the 11 patients with anchoring sutures showed no EVG-related complications. A chronic type B dissection revealed impending rupture due to false lumen infection 1 year after operation and repeat surgery was performed. Stent dislocation occurred in four patients, two of whom required repeat surgery via left thoracotomy due to endoleakage 3 and 4 years after surgery. One died from aneurismal rupture 5 years after surgery. One required emergency graft replacement because of graft perforation 5 years after surgery. The proportion of patients free from EVG-related events at 5 years after surgery was 75%. Anchoring sutures (P = 0.0155) and a large aneurysm of more than 80 mm (P = 0.0190) were predictors of late EVG-related complications. There were five late deaths: two were from stroke, one from rupture, one from cancer, and one from multiple organ failure after repeat surgery. EVG shortens postoperative recovery with relatively lower mortality, but spinal cord injury is a complication occurring with a relatively high rate. Patients with large aneurysms are not good candidates for EVG implantation via median sternotomy Anchoring sutures to fix the EVG to the aortic wall should help prevent EVG-related events and improve the durability of EVG.
Koji Sakurai; Akihiko Usui; Yuuichi Ueda; Toshiaki Akita; Masaharu Yoshikawa; Hiroomi Murayama; Tsuneo Ishiguchi; Kazuki Tajima
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs     Volume:  9     ISSN:  1434-7229     ISO Abbreviation:  J Artif Organs     Publication Date:  2006  
Date Detail:
Created Date:  2006-09-25     Completed Date:  2006-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815648     Medline TA:  J Artif Organs     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  149-53     Citation Subset:  IM    
Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya 466-8550, Japan.
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MeSH Terms
Aged, 80 and over
Aortic Aneurysm, Thoracic / surgery*
Blood Vessel Prosthesis Implantation / methods*
Follow-Up Studies
Middle Aged
Prosthesis Design
Retrospective Studies
Time Factors
Treatment Outcome

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