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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2003 September;10(3):239-53

language: English, Italian

Endovascular treatment of thoracic aorta aneurysms and type B dissections

Civilini E., Moura M. R. L., Tshomba Y., Melissano G., Chiesa R.

Chirurgia Vascolare, IRCCS San Raffaele, Università “Vita-Salute”, Milano


Aim. For ­some ­years, endo­vas­cu­lar treat­ment for aneu­rysms of the descend­ing tho­rac­ic aor­ta and for ­type B dis­sec­tions has ­been pro­posed as a ­less inva­sive alter­na­tive to tra­di­tion­al sur­gery. Our ­3-­year ­initial expe­ri­ence ­using endo­grafts to ­treat ­this dis­ease is ­described.
Methods. Between 1999 and 2002 we treat­ed 24 ­patients (17 men, 7 wom­en; ­mean age 67.3 ­y) ­through the endo­vas­cu­lar ­approach. The ­series com­pris­es 13 aneu­rysms of the descend­ing aor­ta, 4 aneu­rysms of the dis­tal ­arch, 1 ­acute ­type B dis­sec­tion, 3 chron­ic ­type B dis­sec­tions, 2 pen­e­trat­ing ­ulcers, 1 pseu­do-aneu­rysm of the isth­mus. In 8 ­patients a com­bined sur­gi­cal oper­a­tion was per­formed for: syn­chro­nous dis­ease, occlu­sive arte­ri­al dis­ease, inad­e­quate prox­i­mal col­lar.
Results. In all cas­es the endo­graft was implant­ed, ­with suc­cess­ful pri­mary tech­nique in 96% (23/24 cas­es). In no ­case was con­ver­sion to sur­gery nec­es­sary. There was 1 ­case of ­type 1 prox­i­mal endo­leak in a ­patient ­with aneu­rysm of the dis­tal ­arch, ­which ­resolved spon­ta­ne­ous­ly 3 ­months ­after the pro­ce­dure. Four pri­mary endo­leaks ­were treat­ed suc­cess­ful­ly by addi­tion­al endo­graft or prox­i­mal ­cuff. Two ­patients treat­ed for dis­sect­ing tho­rac­ic aneu­rysm (­type B) devel­oped ret­ro­grade per­fu­sion of the ­false ­lumen: 1 ­patient, ­alive at 15-­mo fol­low-up, devel­oped an ­increased max­i­mum diam­e­ter of the aneu­rysm <5 mm; the 2nd ­patient ­died 3 ­mo ­after the pro­ce­dure, prob­ably due to evo­lu­tion of the aor­tic dis­ease. One ­patient ­died in the imme­di­ate ­post-oper­a­tive peri­od, pre­sum­ably due to migra­tion of the endo­graft.
Conclusion. Treatment ­through endo­graft is a val­id alter­na­tive ­even for com­plex dis­eas­es ­such as aneu­rysm of the aor­tic ­arch. The ­long-­term effi­ca­cy of ­this tech­nique is ­still to be eval­u­at­ed ­through con­trolled stud­ies on a sig­nif­i­cant num­ber of ­patients.

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