Endovascular Stent-Graft Placement of Thoracic Aortic Aneurysm

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Conventional surgical repair of descending thoracic aortic aneurysm involves a thoracotomy and graft replacement and has been reported to be associated with high morbidity and mortality rate. Recently, the endovascular stentgraft placement has been newly developed and employed as an alternative therapy for aortic disease. Since August 1995, forty-two patients have undergone transluminal endovascular stentgraft repair of thoracic aortic aneurysm. We used originally-designed Z-stents. The stentgraft was constructed of self-expanding stainless steel Z-stents covered with a woven Dacron polyester fabric graft. We used two parts to the stent-graft. One was a straight graft and the other was a curved one, which was intended to fit well to the distal aortic arch around the left subclavian artery. We implanted these stent-grafts using digital subtraction radio-angiograms. Postoperatively, anti-coagulants were given for six months and were followed-up the patients with a series of spiral CT. Stent-grafts were successfully deployed in 39 patients (93%). There was no emergent conversion to conventional surgical graft replacement. The mortality related to endovascular stent-graft placement was 9.5%. Postoperative morbidity was 11.9% including stent-graft misplacement, intimal injury by stent-graft, stroke, ischemic colitis and transient paraplegia. The space between the endovascular stent-graft and the inner wall of the aneurysm was completely filled with thrombus in 37 patients (88%). Postoperative follow-up was 100% with a mean follow-up of 21.9 months. We conclude that endovascular stent-grafting should be less invasive and more effective for the treatment of thoracic aortic aneurysm although a long-term follow-up of this procedure is mandatory and the results remain to be uncertain.
北里大学の論文
2001-12-31

Endovascular Stent-Graft Placement of Thoracic Aortic Aneurysm

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