PURPOSE: Open surgical repair of descending thoracic aorta aneurysms (DTAA) is frequently associated with pulmonary dysfunction. Although endovascular stent-graft repair has emerged as a viable and less-invasive treatment option for patients with DTAA, little information is available regarding the associated pulmonary sequelae. We reviewed our thoracic endografting experience involving higher-risk surgical patients with DTAA to assess the incidence of pulmonary complications and identify potential risk-factors.
METHODS: Between 2/00 and 4/05, 105 high-surgical-risk patients with DTAA underwent endovascular stent-graft repair as part of a single-center investigational device exemption protocol. Pre-operative comorbidities included: hypertension (83/105, 79.0%), coronary artery disease (47/105, 44.8%), chronic obstructive pulmonary disease (45/105, 42.9%), and renal insufficiency (13/105, 12.4%). Eighty patients (80/105, 76.2%) had a history of smoking with 25 patients (25/105, 23.8%) being active smokers. Six patients (6/105, 5.7%) were on home oxygen therapy. Average ASA classification was 3.6.
RESULTS: Successful stent-graft repair was accomplished in 104 patients (104/105, 99.0%). Mean patient age was 74±8.7years with a 1.2:1 M:F ratio. Vascular access was obtained through the common femoral artery in 89 patients (89/104, 85.6%) and through a retroperitoneal conduit to the common iliac artery or distal aorta in 15 patients (15/104, 14.4%). Eighty-two patients (82/104, 78.8%) were extubated in the operating room, and an additional 13 patients (13/104, 12.5%) were extubated within 24 hours. Seven patients (7/104, 6.7%) required reintubation, and 4 patients (4/104, 3.8%) required a tracheostomy. 3 patients (3/104, 2.9%) developed paraplegia and 4 patients (4/104, 3.8%) suffered a cerebrovascular accident. Reintervention secondary to an endoleak was required in 8 patients (8/104, 7.7%). Mean length of stay was 3±5.3days. Thirty-day mortality was 4.8% (5/104), with 2 patients (2/104, 1.9%) expiring from respiratory failure.
CONCLUSION: Endovascular stent-graft repair of DTAA can be performed safely with minimal pulmonary complications. Risk factors for pulmonary dysfunction include advanced age, renal dysfunction, history of smoking and operative complications.
CLINICAL IMPLICATIONS: Pulmonary complications associated with endovascular repair of the thoracic aorta are less than with open surgical repair, however continued investigation is warranted.
DISCLOSURE: Grayson Wheatley III, Grant monies (from industry related sources) Unrestricted Educational Grant.