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J Thorac Cardiovasc Surg 2006;131:380-387
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Endovascular repair of the thoracic aorta necessitating anchoring of the stent graft across the arch vessels

Maria Schoder, MD a , * , Martin Grabenwöger, MD b , Thomas Hölzenbein, MD c , Manfred Cejna, MD a , Marek P. Ehrlich, MD b , Thomas Rand, MD a , Alfred Stadler, MD a , Martin Czerny, MD b , Christoph M. Domenig, MD c , Christian Loewe, MD a , Johannes Lammer, MD a

a Department of Angiography and Interventional Radiology, University of Vienna Medical, Vienna, Austria
b Cardio-Thoracic Surgery, University of Vienna Medical, Vienna, Austria
c Vascular Surgery, University of Vienna Medical, Vienna, Austria

Received for publication March 2, 2005; revisions received November 2, 2005; accepted for publication November 8, 2005.

* Address for reprints: Maria Schoder, MD, Department of Angiography and Interventional Radiology, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090, Vienna, Austria (Email: maria.schoder{at}meduniwien.ac.at).

OBJECTIVE: The purpose of the study was to determine technical and clinical results in endovascular repair of thoracic aortic diseases necessitating stent-graft anchoring across the arch vessels.

METHODS: The causes for endovascular treatment in 58 patients (aged 20 to 84 years) were aneurysms (n = 32), acute type A (n = 2) and type B dissections (n = 17), posttraumatic transections (n = 4), iatrogenic dissection (n = 1), and penetrating ulcers with an intramural hematoma (n = 2). Surgical revascularization of arch vessels was performed in 26 patients before stent-graft implantation. Intentional overstenting of the left subclavian artery resulted in complete occlusion in 8 and was partial in 24 patients.

RESULTS: The 30-day mortality rate was 3.4%. Overall, 19 major postprocedural complications occurred in 14 (24%) patients. Among patients with left subclavian artery occlusion, 2 patients had major (1 paraplegia, 1 critical arm ischemia), and 3 minor (2 temporary vertebrobasilary symptoms, 1 transient arm claudication) complications. Fourteen (25%) patients had an early endoleak, of whom 5 were treated successfully with a secondary endovascular procedure, 2 necessitated open surgical conversion, and 7 were treated conservatively, with spontaneous sealing of the endoleak in 3. In 53 (91%) in whom computed tomographic follow-up was longer than 3 months (mean, 30.1 months, range, 3 to 85), the aortic diameter along the stented segment decreased in 24, was stable in 19, and increased in 10 patients.

CONCLUSION: Fixation of the stent graft in the aortic arch can expand the applicability of endovascular repair. Intentional overstenting should be performed with caution to avoid ischemic problems after complete occlusion of left subclavian artery.

Abbreviations and Acronyms ASA = American Society of Anesthesiologists; CCA = common carotid artery; CT = computed tomography; CTA = computed tomography-angiography; IMH = intramural hematoma; LSA = left subclavian artery; PAU = penetrating atherosclerotic ulcer; VA = vertebral artery




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