Ces radiol. 2011, 65(2):92-101

Endovascular treatment of descending thoracic aorta and aortic arch diseases - a 10-year experienceOriginal article

Jan Raupach¹, Miroslav Lojík¹, Jan Vojáček², Alexander Ferko³, Antonín Krajina¹, Jan Harrer², Martin Tuna², Vendelín Chovanec¹, Radovan Malý⁴, Pavel Ryška¹, Ondřej Renc¹, Petr Hoffmann¹

¹ Radiologická klinika LF UK a FN, Hradec Králové

² Kardiochirurgická klinika LF UK a FN, Hradec Králové

³ Chirurgická klinika LF UK a FN, Hradec Králové

⁴ I. interní klinika LF UK a FN, Hradec Králové

Aim: Retrospective analysis of efficacy and safety of endovascular treatment of diseases of the descending thoracic aorta and distal aortic arch with thoracic stent-graft.

Method: From May 1999 to December 2010 we treated 58 patients (44 men, 14 women, mean age 59.5 years). These were degenerative aneurysms (n = 5), bleeding degenerative aneurysms (n = 2), aortic ulcers (n = 6), mycotic aneurysms (n = 4), type B aortic dissections (n = 19), traumatic aortic injuries (n = 22). For a short proximal anchoring zone in 3 patients we used a hybrid approach with surgical rerouting technique and then stent-grafting. A total of 58 patients, we introduced 74 stentgrafts (on average 1.3 of the stent graft / patient). Preoperative diagnosis and postoperative monitoring was performed using CT angiography. Follow-up interval was 1-135 months, mean 44.3 months.

Results: Technical success was 98.5% in our group, 30 day mortality was 9.3%, 1-year mortality was 12.9% and overall mortality was 24.1%. Mortality in causal relationship to treatment of aortic disease was 7.4%. Permanent stroke occurred after the treatment in one patient and in one patient developed lower leg paraparesis. Six patients were treated in second period by reintervention with additional stent-graft implantation (2 proximal, 4 distal extensions). In a group of 21 patients with coverage of the left subclavian artery (LSA) in two cases developed claudication of the left upper extremity, once resolved spontaneously and one was solved by the surgery revascularization.

Conclusion: Endovascular treatment of descending thoracic aortic diseases has become first choice in our center. Intentional coverage of the LSA in short and angulated landing zone to improve proximal stabilization of stent-graft and provides an acceptable risk of ischemia of the left upper extremity. Hybrid procedures allow further expansion of endovascular treatment of the aortic arch involvement.

Keywords: thoracic aorta, aneurysm, dissection, aortic trauma, aortic ulcer, endovascular aortic repair, stent-graft, complications

Accepted: March 31, 2011; Published: June 1, 2011  Show citation