Early Results of Endovascular Treatment of the Thoracic Aorta Using the Valiant Endograft

Abstract

Endovascular repair of the thoracic aorta has been adopted as the first-line therapy for much pathology. Initial results from the early-generation endografts have highlighted the potential of this technique. Newer-generation endografts have now been introduced into clinical practice and careful assessment of their performance should be mandatory. This study describes the initial experience with the Valiant endograft and makes comparisons with similar series documenting previous-generation endografts. Data were retrospectively collected on 180 patients treated with the Valiant endograft at seven European centers between March 2005 and October 2006. The patient cohort consisted of 66 patients with thoracic aneurysms, 22 with thoracoabdominal aneurysms, 19 with an acute aortic syndrome, 52 with aneurysmal degeneration of a chronic dissection, and 21 patients with traumatic aortic transection. The overall 30-day mortality for the series was 7.2%, with a stroke rate of 3.8% and a paraplegia rate of 3.3%. Subgroup analysis demonstrated that mortality differed significantly between different indications; thoracic aneurysms (6.1%), thoracoabdominal aneurysms (27.3%), acute aortic syndrome (10.5%), chronic dissections (1.9%), and acute transections (0%). Adjunctive surgical procedures were required in 63 patients, and 51% of patients had grafts deployed proximal to the left subclavian artery. Comparison with a series of earlier-generation grafts demonstrated a significant increase in complexity of procedure as assessed by graft implantation site, number of grafts and patient comorbidity. The data demonstrate acceptable results for a new-generation endograft in series of patients with diverse thoracic aortic pathology. Comparison of clinical outcomes between different endografts poses considerable challenges due to differing case complexity.

Endovascular Stent-Graft or Open Surgical Repair for Blunt Thoracic Aortic Trauma: Systematic Review

“…In these cases of catheter and device manipulation and fixation at the arch, stroke remains a concern. However, the stroke incidence was 0.9% in the reviewed literature, which is more comparable to the rates accepted for cerebral angiography than the 3%-4% rates reported in TEVAR for degenerative pathologic processes (73,(101)(102)(103).…”

How to manage the left subclavian artery during endovascular stenting of the thoracic aorta☆

“…In addition, the individual presentation must be considered to ensure that there are no specific influencing factors such as a previous LIMA harvest for CABG. The underlying aortic pathology and clinical urgency did not appear to significantly influence the outcome, according to our results, despite the expectation that the extent of aortic dissection may influence the rate of spinal-cord ischaemia due to varying degrees of interruption of spinal-cord perfusion [13].…”

“…In addition, the length of thoracoabdominal aorta covered by a stent graft or the degree of LSA coverage would be expected to influence the outcome and this information too was not available. The degree of preexisting disease of cerebral and intra-arch vasculature is also known to affect the stroke rate and this was not factored for in this study [13].…”

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

“…Recent data on endovascular repair of chronic complicated TBAD reveal excellent procedural and survival outcomes, but at the expense of further re-interventions. The rates of stroke following endovascular-based repair ranged between 0% to 5%, it was 0% to 2% for paraplegia, up to 14% procedure-related mortality (20)(21)(22)(23)(24)(25)58,60,(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74) (Table 7).…”