Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts

Endovascular Treatment of Thoracic Aortic Disease

“…Furthermore, the sudden deployment of the stent followed by the occlusion of the intercostal branches does not produce steal syndrome in the perfusion of the spinal cord. 9 In patients with type B dissection, the use of short stent grafts and deployment far from vertebrae T8 to L2 further minimizes the risk of paraplegia, as compared with the risk of surgical aortic replacement and graft interposition. 7,8 Most important, endoluminal stenting is a much shorter procedure than surgery.…”

“…After initial "pioneer-like" attempts performed in a few institutions, 4 -6 the endovascular stent graft treatment has emerged as a valid option in the management of all kinds of aortic disease. [7][8][9][10][11][12][13][14][15][16][17][18] Especially in the high-risk setting of patients affected by aortic dissection, endoluminal repair is a new therapeutic strategy that is yielding encouraging results. 7,8,14,15,17,18 Furthermore, some reports have appeared on stent graft repair of post-traumatic pseudoaneurysms.…”

Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms

“…Overall, successful device deployment is achieved in 85% to 100% of cases, and periprocedural mortality ranges from 0% to 14%, falling within or below elective surgery mortality rates of 5% to 20%. 68,[75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] As expected, outcomes have improved over time with accumulated technical expertise, use of commercially manufactured devices, and improved patient selection criteria. The recently published collective experiences of the EUROSTAR and United Kingdom Thoracic Endograft registries, the largest series to date (nϭ249), demonstrate successful deployment in 87% of cases, 30-day mortality of 5% for elective cases, and paraplegia and endoleak rates of 4%.…”

“…Indeed, this has held true, with paraplegia rates generally ranging from 0% to 5% in endovascular studies, 68,[75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] whereas paraplegia occurs in 5% to 25% of open repair cases. 56,58,64,65 Although low, these rates remain significant, especially because it is impossible to reimplant intercostal arteries in this setting.…”

Contemporary Management of Descending Thoracic and Thoracoabdominal Aortic Aneurysms: Endovascular Versus Open

“…Similarly, several reviews have noted that 8% to 43% of landing sites in descending aortic aneurysms will not allow an appropriate 2-cm length for secure proximal fixation. 73,74,76,77 Indeed, in 20% of our patients, the left subclavian artery was intentionally covered (11.5% underwent preprocedural subclavian artery bypass). The 4-year survival after endovascular repair was 54%, and the freedom from reintervention rate was 81%.…”