Surgical mortality for repair of thoracic aortic pathologies is high, hence percutaneous endoluminal grafting (ELG) is being investigated as an alternative therapy. The purpose of the study is to describe the outcomes of ELG in patients eligible or high risk for open surgical repair.
Between March 1998 and December 2003, ELG of the thoracic aorta was performed in 201 patients (mean age 70; 124 male, 77 female). Gore-Excluder graft was used in 115 cases, Endomed in 63 and Talent in 23. Demographics, aortic morphology, sac changes, CT scans and complications were recorded.
Aortic pathology included aneurysms 55%, dissections 22.4%, aortobronchial fistulas 2.5%, pseudoaneurysms 9%, traumatic transactions 2.5%, and penetrating ulcers 6%. A single graft was used in 122 (60.7%), 2 grafts in 57 (28.4%), and 3 or more in 22 patients (11%). An emergent treatment was rendered in 44/201 (22%) for ruptured aneurysms. All cases were classified from Level I thru IV based on morphology of <60° angle curvature. There were 87 (43.3%) level I, 61 (30.7%) level II, 24 (11.9%) level III, and 7 (3.9%) level IV. Overall morbidity was 23% with respiratory failure (4.4%), bowel ischemia (2.4%), acute renal failure (3%), ruptured vessel (2%), graft migration (1.5%), collapsed graft (2%) and open surgical conversion in 1 patient. Paraplegia and paraparesis occurred in 4 and 6 patients, respectively. Regression analysis revealed type of graft (Talent) (p= .0001), retroperitoneal approach (p=.048), and number of grafts (3 or more) (p=.007) to be predictors of paraplegia. Aortic morphology level IV was an independent predictor of early interventions (p=.015), and type of graft (Talent) of endoleak (p=.049). A 30 day mortality was 5.4% (11 patients). Mean aneurysmal sac changed from 6.2cm preoperatively to 5.23cm postoperatively (p=.0001).
Patients with thoracic aneurysms can benefit from endoluminal grafting, however, morphology, type of graft, and approach, graft sizing and number are of paramount importance in case selection.
Endoluminal grafting is evolving as a primary treatment in thoracic aortic pathologies.
J. Rodriguez, None.