Endovascular repair of the thoracic aorta: Initial and mid-term results in 113 patients

Aim. Several studies confirmed the short-term efficacy of endovascular treatment of thoracic pathology with reduced morbidity and mortality rates. The aim of this prospective study is to evaluate midterm results of this procedure performed at our Institution with covered stent graft. Methods. In the last 6 years (1999-January 2005), 113 selected patients underwent thoracic endografting with different devices. The disease involved the arch in 32 cases, the descending thoracic aorta in 75 cases and the thoracoabdominal aorta in 6 cases. All procedures were performed in the operating room, under general anesthesia in 68 cases and local/spinal anesthesia in 45 cases. In 28 cases we used a hybrid procedure either to assess an adequate proximal or distal landing zone in case of aortic arch or thoracoabdominal aortic involvement or to reduce the perioperative risk in presence of synchronous aortic pathology. Results. Technical success was achieved in 94.7% cases (107/113). In-hospital mortality was 4.5% (5/113). We observed 5 cases of type Ia endoleak not susceptible of adjunctive endovascular procedures, 3 of these endoleaks resolved at 6 months follow-up. We recorded the following complications: 5 cases of delayed paraplegia resolved after cerebrospinal fluid drainage and adequate hemodynamic control. One case of acute renal failure that did not required hemodialysis. At a mean follow-up of 35 ± 14 months we recorded 7 late deaths (5 not aneurysm-related) and 3 conversions to open surgery. Conclusion. Thoracic endografting proved to be safe and allowed satisfactory mid-term results in our 6 year experience, nonetheless, postoperative complications are still noteworthy, in particular for aortic arch aneurysms. Hybrid approach may extend the applicability of endovascular procedures to complex cases.