Challenges of endovascular tube graft repair of thoracic aortic aneurysm: midterm follow-up and lessons learned

Abstract

While promising, this midterm experience with commercially available devices highlights the shortcomings of current stent-graft technology. Three significant advancements are required to fulfill the potential of this important treatment method: a stent graft with a durable proximal and distal fixation device, enhanced engineering to accommodate high thoracic aortic fatigue forces, and a mechanism to adapt to aortic arch and visceral segment branches to enable treatment of lesions that extend to or include these vessels.

Thoracic and Abdominal Aortic Aneurysms

“…This technique has the advantage of being far less invasive than surgery, with potentially fewer postoperative complications and lower morbidity. Ellozy et al 29 recently reported a series of 84 patients receiving endovascular stent-grafts to treat descending thoracic aortic aneurysms. Primary technical success was achieved in 90%, and successful exclusion of the aneurysm was achieved in 82%.…”

Tratamiento endovascular del trauma de aorta descendente

“…Esta complicación ha sido reportada ocasionalmente en el manejo endovascular electivo de aneurismas de la aorta descendente, con mucha menor frecuencia que en la cirugía abierta 12,13 . Incluso en series recientes de reparación endovascular de lesiones aneurismáticas en general, no se reportan casos de paraplejia 16,[24][25][26] o incidencias inferiores a 2,5% 27,28 . En la presente serie, aunque pequeña, no tuvimos que lamentar esta devastadora complicación.…”

Endovascular Treatment of Descending Thoracic Aortic Aneurysms

“…[35] The rates of endoleak reported in literature vary and depend upon the type of pathology treated, and the length of the follow-up. Parmer et al [36] reported an endoleak incidence of 29% at an average follow-up of 17 months, Ellozy et al [37] published an incidence of 18% at roughly 15 months, and the Gore-TAG trial [38] reported only 10.6% at 5 years.…”

“…Other smaller experiences in literature with follow-ups ranging from 15 -40 months presented a percentage of rupture at a distance between 1.6% and 6%. [37,43,44] …”