Australia & New Zealand Society of Vascular Surgeons

Objectives Endovascular stent grafting (endografting) holds great potential as a minimally invasive alternative to open surgery for thoracic aortic aneurysms. However, systems universally applicable to aneurysms of the descending thoracic aorta are still under trial. Experience of endografting by our homemade systems crafted particularly for the thoracic aorta is reported. Patients and Method From February 1995 to February 2003, 309 patients with thoracic aortic aneurysm or aortic dissection were treated by our homemade endograft system. Etiological studies of 185 patients with aneurysm located in the descending thoracic aorta revealed sclerotic origin in 142, anastomotic site origin in 20, traumatic origin in 17 and inflammatory origin in 6. The basic framework of our endograft consisted of modified Z stents with each unit joined by longitudinal struts, and covered with a thin-wall woven polyester vascular graft. Under fluoroscopy in the operating theatre, the endograft is delivered to the aorta through a 20-22F Teflon sheath introduced by the brachial-femoral traction wire technique we have named ‘tug of wire’. Results Endograft was successfully delivered to the target region in 182 patients (98%). The proximal end of the endograft was deployed in the landing zone map of Z0 (n=14), Z1 (n=15), Z2 (n=40), Z3 (n=60) and Z4 (n=53). Aneurysm exclusion was successfully achieved by endograft deployment in 166 patients (91%). As for major adverse events, there were 4 cerebral infarctions, 4 aortic dissections and 4 aneurysm ruptures. Transient paraparesis was observed in 3 patients after endografting for aneurysms located in the critical region of spinal cord ischemia. Ten patients died of causes related to the procedure. Our custom-made endograft designed for fitting to the configuration of the aorta in each individual patient, enabled successful endografting for the distal arch or the proximal descending aorta. Pre-deployment tests using a novel retrievable endograft helps to predict the possibility of spinal cord ischemia. The mid-term follow-up results revealed that shrinkage of the aneurysm was observed in 60% of the patients in whom endoleak was not detected. The overall survival rate was 77% at 3 years. Conclusions Endografting is feasible as one treatment option for thoracic aortic aneurysm. Selection of proper indications, development of a good quality device and technical improvement are keys to successful endografting.