THE FIRST-GENERATION OF ENDOVASCULAR STENT-GRAFTS FOR PATIENTS WITH ANEURYSMS OF THE DESCENDING THORACIC AORTA

DAKE MD MILLER DC MITCHELL RS SEMBA CP MOORE KA SAKAI T

Md. Dake et al., THE FIRST-GENERATION OF ENDOVASCULAR STENT-GRAFTS FOR PATIENTS WITH ANEURYSMS OF THE DESCENDING THORACIC AORTA, Journal of thoracic and cardiovascular surgery, 116(5), 1998, pp. 689-703

30

INGLESE

Article

Cardiac & Cardiovascular System",Surgery

Journal of thoracic and cardiovascular surgery → ACNP

0022-5223

116

5

1998

689 - 703

ISI

0022-5223(1998)116:5<689:TFOESF>2.0.ZU;2-J

Objective: Our goal was to determine whether endovascular stent-grafti ng is feasible and effective for patients with aneurysms of the descen ding thoracic aorta. Methods: Starting in July 1992, we conducted a pr ospective, uncontrolled clinical trial in 103 patients (mean age 69 ye ars [range 34-89 years]) who underwent endovascular treatment of aneur ysms of the descending thoracic aorta using a custom-fabricated, self- expanding stent-graft device, Follow-up was 100% complete and averaged 22 months. Sixty-two patients (60%) were judged not to be reasonable candidates for a conventional ''open'' surgical procedure. Results: Co mplete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients. The early mortality rate was 9% +/- 3% (+/- 70% CL). Multiva riable analysis revealed that myocardial infarction pr stroke was link ed with a higher likelihood of early death (P = .001), Early serious c omplications included paraplegia in 3% +/- 2% and stroke in 7% +/- 3%, Actuarial survival estimates at 1 year and 2 years were 81% +/- 4% an d 73% +/- 5% (+/- 1 SE), respectively; being judged not to be a surgic al candidate portended a higher probability of death (P = .003). Accor ding to the intent-to-treat principle, ''treatment failure'' (includin g all late sudden unexplained deaths) occurred in 38 patients; 53% +/- 10% of patients were free from treatment failure at 3.7 years. Stent- graft related com; plications occurred commonly and were Linked with s everal anatomic, technical, and patient-related risk factors. Conclusi ons: This 5-year clinical trial involving use of a ''first generation' ' device indicates that endovascular stent-grafting of descending thor acic aortic aneurysms is feasible with acceptable medium-term results. More refined, commercially developed devices available today offer le ss traumatic and more precise stent-graft deployment; these major tech nical advantages, coupled with important lessons we have learned over time and better patient selection, should be associated with more salu tary clinical results in the future.