Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Thoracic EndoVascular Stent Graft Repair for Aortic Aneurysm

  • Kim, Joung-Taek (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital) ;
  • Yoon, Yong-Han (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital) ;
  • Lim, Hyun-Kyung (Department of Anesthesiology and Pain Medicine, Inha University Hospital) ;
  • Yang, Ki-Hwan (Department of Anesthesiology and Pain Medicine, Inha University Hospital) ;
  • Baek, Wan-Ki (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital) ;
  • Kim, Kwang-Ho (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital)
  • Received : 2010.07.13
  • Accepted : 2011.03.17
  • Published : 2011.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The number of cases employing thoracic endovascular aortic repair (TEVAR) has been increasing due to lower morbidity and mortality compared to open repair technique. The aim of this study is to evaluate the outcome of TEVAR for thoracic aortic diseases. Materials and Methods: Sixteen patients underwent TEVAR from October 2003 to April 2010. Mean age at operation was 59 years (20~78 years), and 11 were male. Indications for TEVAR were large aortic diameter (>5.5 cm) upon presentation in 6 patients, increasing aortic diameter during the follow-up period in 4, traumatic aortic rupture in 3, persistent chest pain in 2, and ruptured aortic aneurysm in one. The mean diameter, length and the number of the stents were 33 mm (26~40 mm), 12 cm (9.5~16.0 cm), and 1.25 (1~2), respectively. Aortography employing Multi-detector computerized tomography (MDCT) technique was performed at one week, and patients were followed up in the out-patient department at one month, 6 months, and one year postoperatively. Results: Primary technical success showing complete exclusion of the aneurysm was achieved in 15 patients. One patient showed a small endo-leak (type 1). Four patients developed perioperative stroke: Three recovered without sequelae, and one showed mild right-side weakness. There was no operative mortality. Diameter of the thoracic aorta covered by stent graft changed within 10% range in 12 patients, decreased by more than 10% in 3, and increased by more than 10% in one during mean follow-up duration of 18 months (1~73 months). There was no recurrence-related death during this period. Conclusion: Intermediate-term outcome after TEVAR was encouraging. Indications for TEVAR could be extended for other thoracic aortic diseases.

Keywords

References

  1. Kim JT, Geon YS, Baek WK, Yoon YH, Kim YS, Kim KH. Use of percutaneous endovascular stent graft in patients with thoracic aneusrysm. Korean J Thorac Cardiovasc Surg 2006;39:157-61.
  2. Wang GJ, Fairman RM. Endovacsular repair of the thoracic aorta. Semin Intervent Radiol 2009;26:17-21. https://doi.org/10.1055/s-0029-1208379
  3. Antoniou GA, Sakka KE, Hamady M, Wolfe JHN. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg 2010;39:683-90. https://doi.org/10.1016/j.ejvs.2010.02.002
  4. Matsumura JS, Cambria RP, Dake MD, Moore RD, Svensson LG, Snyder S. International controlled clinical trial of thoracic endovascular repair with Zeith TX2 endovascular graft: 1-year results. J Vasc Surg 2008;47:247-57. https://doi.org/10.1016/j.jvs.2007.10.032
  5. Neschis DG, Scalea TM, Flinn WR, Griffith BP. Blunt aortic injury. N Engl J Med 2008;359:1708-16. https://doi.org/10.1056/NEJMra0706159
  6. Nienaber CA, Zannetti S, Kische S, Schareck W, Rehders TC. Investication of stent graft in patients with type B aortic dissection: design of the INSTEAD trial-prospective, multicenter, European randomized trial. Am Heart J 2005;149:592-9. https://doi.org/10.1016/j.ahj.2004.05.060
  7. Song JM, Kim SD, Kim JH, et al. Long-term predictors of descending aorta aneurismal change in patients with aortic dissection. JACC 2007;50:799-804. https://doi.org/10.1016/j.jacc.2007.03.064
  8. Chemelli-Steingruber IE, Chemelli A, Strasak A, Hugl B, Hiemetzberger R, Czermak BV. Evaluation of volumetric measurements in patients with acute type B aortic dissection-TEVAR vs conservative. J Vasc Surg 2009;49:20-8. https://doi.org/10.1016/j.jvs.2008.08.062
  9. Tsai TT, Evangelista A, Nienaber CA, et al. Partial thrombosis of false lumen in patients with acute type B aortic dissection. N Engl J Med 2007;357:349-59. https://doi.org/10.1056/NEJMoa063232
  10. Chemelli-Steingruber IE, Chemelli A, Strasak A, et al. Endovascular repair or medical treatment of acute type B aortic dissection? A comparision. Eur J Radiol 2008;73:175-80.
  11. Patel HJ, William DM. Endovascular therapy for malperfusion in acute type B aortic dissection. Oper Tech Thorac Cardiovasc Surg 2009;14:2-11. https://doi.org/10.1053/j.optechstcvs.2007.10.001
  12. Szeto WY, Mcgarvey M, Pochettino A, et al. Results of a new surgical paradigm:endovascular repair for acute complicated type B aortic dissection. Ann Thorac Surg 2008;86:87-94. https://doi.org/10.1016/j.athoracsur.2008.04.003
  13. Patel HJ, William DM, Meekov M, Dasika NL, Upchurch GR, Deeb GM. Long-term results of percutaneous management of malperfusion in acute type B aortic dissection: implications for thoracic aortic endovascular repair. J Thorac Cardiovasc Surg 2009;138:300-8. https://doi.org/10.1016/j.jtcvs.2009.01.037
  14. Tang DG, Dake MD. TEVAR for acute uncomplicated aortic dissection: immediate repair versus medical therapy. Semin Vasc Surg 2009;22:145-51. https://doi.org/10.1053/j.semvascsurg.2009.07.005
  15. Kato N, Hirano T, Ishida M, et al. Acute and contained rupture of the descending thoracic aorta: treatment with endovascular stent-grafts. J Vasc Surg 2003;37:100-5. https://doi.org/10.1067/mva.2003.68
  16. Shimono T, Kato N, Yasuda F, et al. Transluminal stentgraft placements for the treatments of acute onset and chronic aortic dissection. Circulation 2002;106:1241-7.
  17. Conrad MF, Crawford RS, Kwolek CJ, Brewster DC, Brady TJ, Cambria RP. Aortic remodeling after endovascular repair of acute complicated type B aortic dissection. J Vasc Surg 2009;50:510-7. https://doi.org/10.1016/j.jvs.2009.04.038
  18. Marui A, Mochizuki T, Mitsui N, Koyama T, Kimura F, Horibe M. Toward the best treatment for uncomplicated patients with type B acute aortic dissection. Circulation 1999;100(suppl II):275-80.
  19. Song TK, Donayre CE, Walot I, et al. Endograft exclusion of acute and chronic descending thoracic aortic dissections. J Vasc Surg 2006;43:247-58. https://doi.org/10.1016/j.jvs.2005.10.065

Cited by

  1. Aortopulmonary Fistula Presenting without an Endoleak after Thoracic Endovascular Aortic Repair vol.50, pp.4, 2011, https://doi.org/10.5090/kjtcs.2017.50.4.287
  2. Aortic Isthmus Narrowing after Endovascular Repair of Acute Traumatic Aortic Transection vol.34, pp.3, 2018, https://doi.org/10.5758/vsi.2018.34.3.77