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BACKGROUND:
Endovascular stent graft repair of the thoracic aorta is a field undergoing rapid evolution. We report on the hypothesis that results are improving with new stent design iterations and describe our experience and lessons learned with multiple early and later generations of Thoracic Aortic Stent Grafts.
METHODS:
From April 1999 to December 2004, 92 patients underwent thoracic aortic endovascular stent graft repair. Each patient was enrolled as part of 3 distinct phase I or phase II FDA approved clinical trials.
RESULTS:
Average patient age was 74 years (range 34 - 93 years).No procedures had to be aborted. Thirty day peri-op mortality was 3.3% (n=3). There were 4 cases of post operative paraparesis and 1 case of paraplegia. Periop vascular complications which required bypass grafting, thrombectomy or patch repair occurred in 14.1% (n=13). Over the follow up period 9 patients developed a Type I endoleak and 2 had Type III endoleaks. The incidence of endoleak was markedly lower with the later generation grafts. At 5 year follow up, overall mortality was 19.2% (n=18). Of these, two were graft related deaths.
CONCLUSIONS:
Thoracic aortic stent grafting is a safe procedure in selected patients with low periop mortality rates, low incidence of paraplegia and acceptable long term survival. Results are improving as technology evolves. This trend has important implications for future treatment of thoracic aortic disease. The impact of continued evolution of thoracic aortic stent grafting may adjust our indications for intervention and radically change our therapeutic options.