Device-spezifische Probleme thorakaler Endostents

Abstract

The outcome of the endovascular repair of abdominal aortic aneurysms seems to be device related. The presented study evaluated the outcome of endovascular procedure in cases of thoracic aortic pathology according to the implanted thoracic stent graft devices. Since November 1999 a variety of thoracic aortic pathologies in 59 patients has been treated endovascularly. The median age of the cohort (53 males, 6 females) was 64 years (rang, 21 to 83). The patients presented the following aortic morphology: aneurysm n = 23, dissections with aneurysm n = 9, dissection without aneurysm n = 9, intramural hematoma n = 2, penetrating ulcers n = 2, transsection n = 8, false aneurysm n = 6. The underlying pathology was: atherosclerotic medial degeneration n = 25, acute dissection (< 14 days) n = 10, chronic dissection (> or = 14 days) n = 10, trauma n = 8, iatrogenic n = 6. Three patients presented the symptoms of aortic pulmonary fistulas; one patient was treated due to traumatic aortic oesophageal fistula. The used stent graft devices included the GORE TAG (n = 35), the Talent device (n = 13), the Cook device (Zenith TX 1: n = 5), and the Endofit device (n = 3). At three cases a home-made device (n = 1) or a combination of different stent grafts was implanted (Talent plus TAG, Talent plus TX1). Totally, 93 stent grafts were primarily implanted. The 30-day mortality was 1 / 59. One patient with acute dissection (Stanford type B) suffered from a per-procedural acute retrograde dissection leading to death in spite of the performed Bentall's procedure. Per-operatively, one patient showed cerebral ischemia, one other patient experienced a transsection of the external iliac artery due to the retraction of the introducer sheath, and another patient showed an extravasation of contrast dye. 24 hours following the endovascular procedure, one patient developed paraplegia without regression in spite of performing a spinal drainage. The passage of the introducer sheath of the primarily chosen device was impossible at three cases, in another three cases type I endoleaks were detectable, a type III endoleak was evident at another patient with formerly implanted multiple stent grafts. The results of the endovascular procedures in treatment of thoracic aortic pathologies demonstrated typically device related problems and unwanted events. Various types of stent grafts, introducer sheaths, and delivery systems may be necessary to satisfy the different requirements for different indications.