Complications after endovascular stent-grafting of thoracic aortic diseases

Abstract

Background: To update our experience with thoracic aortic stent-graft treatment over a 5-year period, with special consideration for the occurrence and management of complications.

Methods: From December 2000 to June 2006, 52 patients with thoracic aortic pathologies underwent endovascular repair; there were 43 males (83%) and 9 females, mean age 63 +/- 19 years (range 17-87). Fourteen patients (27%) were treated for degenerative thoracic aortic aneurysm, 12 patients (24%) for penetrating aortic ulcer, 8 patients (15%) for blunt traumatic injury, 7 patients (13%) for acute type B dissection, 6 patients (11%) for a type B dissecting aneurysm; 5 patients (10%) with thoraco-abdominal aortic aneurysms were excluded from the analyses. Fifteen patients (32%) underwent emergency treatment. Overall, mean EuroSCORE was 9 +/- 3 (median 15, range 3-19). All procedures were performed in the theatre under general anesthesia. All complications occurring during hospitalisation were recorded. Follow-up protocol featured CT-A, and chest X-rays 1, 4 and 12 months after intervention, and annually thereafter.

Results: Primary technical success was achieved in all patients; procedures never aborted because of access difficulty. Conversion to standard open repair was never required. Mean duration of the procedure was 119 +/- 75 minutes (median 90, range 45-285). Mean blood loss was 254 mL (range 50-1200 mL). The mean length of the aorta covered by the SGs was 192 +/- 21 mm (range 100-360). The LSA was over-stented in 17 cases (17/47, 36%). Overall 30-day operative mortality was 6.4% (3/47). Major complications included pneumonia (n = 9), cerebrovascular accidents (n = 4), arrhythmia (n = 4), acute renal failure (n = 3), and colic ischemia (n = 1). Overall, endoleak rate was 14%.

Conclusion: Although this report is a retrospective and not comparative analysis of thoracic aortic repair, the combined minor and major morbidity rate was lower than previous reported to results of either electively and emergency performed conventional repair.

Figure 1

Preoperative CT-A shows an 8-cm saccular aneurysm of the distal arch (A, B); MIP reconstructions shows the involvement of the LSA (C).

Figure 2

Intraoperative preliminary DSA (A) confirm the presence of a "lusoria artery" (arrow). Final DSA (B) confirmed the complete exclusion of the aneurysm and the patency of the left common carotid artery (black arrow) and the re-filling of the LSA via the ipsilateral LVA (white arrow).

Figure 3

Follow-up CT-A showed late type Ib endoleak (arrow) after SG treatment of a type B dissecting aneurysm (A). Preliminary DSA (B) confirmed the re-perfusion of the false channel through a distal re-entry tear (arrow): additional SG was used to seal the aneurysm as confirmed by final DSA (C) with TEE control.