Midterm Results of Stent‐Graft Repair for Thoracic Aortic Aneurysms: Computed Tomographic Evaluation

Abstract

Midterm observation of endovascular surgery using a fabric-covered stent graft for thoracic aortic aneurysms is discussed with postoperative follow-up findings based on regularly performed thoracic computed tomography (CT). From 1996 to 1999, 20 patients with thoracic aortic aneurysm underwent stent-graft placement in our hospital. One year follow-up CT results after placement were obtained for 17 patients. The CT scans found that there were both thrombosis and size reduction of aneurysm in 8 patients (46%), thrombosis without size reduction in 2 (13%), a new ulcerlike projection (ULP) in 3 (19%), persistent minor endoleakage in 2 (13%), a new endoleak in 1 (6%), and a recurrent endoleak from intercostal arteries in 1 (6%). The new ULP formation seemed to be a peculiar problem stemming from an intimal injury caused by edges of the stent. Therefore, we recently adopted a new spiral stent instead of the previous stent to avoid the injury. The new endoleak suggested that aneurysmal thrombosis without size reduction could cause the aneurysm to develop recurrent endoleaks. From these findings, we concluded that midterm observation of stent-graft repair for thoracic aortic aneurysms did not give satisfactory results. In order to improve the results of endovascular surgery using stent-grafts, we need to develop safer stent grafts with a reliable design to prevent endoleaks and to avoid intimal injury of the aorta. We also hope to develop effective technologies that can accelerate organization of thrombus in the aortic aneurysm after stent-graft placement.

Endovascular Treatment of Thoracic Aortic Aneurysms

“…Unlike studies of abdominal aortic endograft devices, there are no prospective evaluations of thoracic stent grafts in the literature. Rather, the literature is replete with anecdotal, retrospective experiences of endovascular treatment of thoracic aneurysms 13 , 18‐23 . Available studies are clouded with the inclusion of aortic dissection and aneurysms, two quite distinct clinical entities.…”

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

“…4) [15]. In some cases we found additional shrinkage of the thrombosed aneurysms, which is a common finding after endovascular stent grafting too [16].…”

Neuere Aspekte in der Chirurgie der thorakalen Aorta

“…Nach Auskühlung auf ein Hypothermieniveau von 24 18 Minuten in einem Bereich lag, der in einigen Studien als weniger kritisch angesehen wird. Betrachtet man jedoch die 30-Tage-Sterblichkeit in der Hochrisikosubgruppe der akuten Typ-A-Dissektionen in den Jahren September 1990 bis Dezember 1997 versus Januar 1998 bis August 2001, bei denen ein kompletter Bogenersatz vorgenommen werden musste, so konnte eine Reduktion von 29,7% auf 23,6% registriert werden.…”

“…Endoleckagen, ähnlich wie bei der Versorgung abdomineller Aneurysmen, eine bekannte Spätkomplikation dar [23]. Sie stehen der ansonsten in 46% der Fälle beobachteten Komplettthrombosierung des Aneurysmas oder des falschen Lumens mit Reduktion des Gesamtdurchmessers und der in 13% erfolgenden Thrombosierung ohne Reduktion des Durchmessers entgegen [24]. In den meisten Fällen kann mit einer Reintervention nachkorrigiert werden, wobei die Inzidenz sekundärer Interventionen nach 2 Jahren mit Werten zwischen 15 und 40% relativ hoch erscheint.…”