Objective: Management of penetrating atherosclerotic ulcers (PAU), intramural hematomas (IMH), and acute aortic dissections (AD) of the thoracic aorta remain controversial in the endovascular era.
Methods: Between 2001 and 2007, patients with PAU (13 patients), and/or IMH (7 patients) were treated with thoracic endografts (TEVAR) in the endovascular suite under general anesthesia. Indications for intervention were intractable chest pain, expanding hematoma or contained rupture, or distal malperfusion. End-points were early morbidity and mortality, incidence of endoleak, device-related complications, and secondary interventions.
Results: Of the 20 patients with a median age of 67 (25-83), 13 (65%) were men, 2 (10%) had contained aortic rupture, and 10 were symptomatic. One patient had carotid-subclavian bypass debranching before endograft implantation. Ten patients had cerebrospinal fluid drainage. Mean length of aorta treated was 122.1 mm (range 36-300). All endografts were technically successful. Average blood loss was 50 mL. Thirty-day mortality was 0%. Symptoms resolved in all patients; there were no neurologic complications. Average length of stay was 5 days. Mean follow-up was 2.0 years (range 0.1-5.8). All patients remained asymptomatic. Three had early (<180 days) endoleaks: Two type II and 1 type I treated successfully with an additional cuff, which was the only patient requiring reintervention. Two patients had late (>180 days) endoleaks (type 2) observed with no aortic expansion. Two deaths at 5.4 and 5.8 years were due to severe aortic valve stenosis and metastatic lung cancer.
Conclusion: TEVAR is a feasible option for repair of non-aneurysmal thoracic aortic pathology with resolution of symptoms, no mortality, and no neurologic complications.
Copyright 2009 Wiley-Liss, Inc.