Endovascular repair of lesions involving the descending thoracic aorta. Mid-term morphological changes

Abstract

Thoracic aortic lesions are often life-threatening conditions with significant morbidity and mortality after open surgical repair. If preliminary results suggest that endovascular therapy is an effective and advantageous treatment, long-term effectiveness remains questionable. We analysed 75 consecutive patients who underwent endovascular stent-grafting of lesions involving the descending thoracic aorta (32 emergent, 43 elective). Aortic pathologies were aneurysms (n=31), chronic (n=8) or complicated (n=6) type B dissections, penetrating ulcers (n=4) or aortic ruptures (n=26). Follow-up was performed using magnetic resonance angiography. In three cases, the procedure was stopped due to inappropriate arterial access calibre. The hospital mortality and morbidity were 8% and 12%, respectively. One patient of the chronic group presented a type I endoleak, treated by embolisation. After 1.5 months, the mortality and morbidity rates were 10.6% and 10.6%, respectively. The secondary endoleak rate was 16%. One patient died of aortic rupture 24 months after the procedure. In the aneurysm group, the regression of the aortic calibre was significant in 23 and stable in 28 patients. Thus, and despite encouraging early outcomes, mid-term results suggest a trend toward increased re-intervention and late complication rates in these high surgical risk patients. Therefore, continued surveillance of patients treated with stent-grafts is necessary.