Australia & New Zealand Society of Vascular Surgeons

Aim The safety, efficacy and feasibility for the endovascular repair of thoracic aortic aneurysm and dissections were retrospectively analysed. Method From Aug 1998 to Aug 2003, 14 cases with true thoracic aortic aneurysm and pseudoaneurysm (Group 1) and 62 cases with thoracic aortic dissection (Group 2) were treated by endovascular devices. CTA or MRA were used to obtain the morphology of the lesions and the diameter and length of the proximal landing zone. The stent graft was deployed at the proximal neck of the aneurysm or first tear entry in aortic dissection through the iliac or femoral artery under fluoroscopic control. The stent grafts used were Vanguard (n=1), Talent (n=65) and domestic stent grafts (n=10). Results In Group 1, 10 aneurysms located between T5-T8, 2 aneurysms located between T8-T12 and 2 thoracic abdominal aortic aneurysms (TAAA) were treated. 2 left subclavian artery (LSA) bypasses were performed because of short proximal neck and poor right vertebral artery blood supply. Another case had endovascular repair associated with open surgery. All of the stent grafts were placed correctly. One patient died from myocardic infarction 7 days after the endovascular procedure. 2 cases had type I endoleak. There were no paraplegic complications. In Group 2, there were 51 chronic and 11 acute dissections. 56 patients had Stanford B dissection and 6 patients with first tear entry at aortic isthmus but retrograde to ascending thoracic aorta (Stanford A). The first tear entry position was 52 located at isthmus of thoracic aorta and 10 located between T8-L1. There was only one entry in 2 cases and more than 2 entries in 46 cases. There were variable patterns of visceral and renal artery problems which will be described. In Group 2, all of the procedures were a technical success. One patient with acute dissection died because of a new retrograded dissection and cardiac tamponade one day after the procedure. Intentional stent graft coverage of the subclavian artery without bypass was performed in 16 selected cases. The average pressure of the left brachial artery was 56 mmHg after deployment. 4 patients complained of post-interventional exercise-dependent paraesthesia without difference between the upper extremities strength. The endoleak rate was 19.2%. There were no surgical conversions, paraplegia and end organ or limb ischaemia complication in this group within 30 days after the procedure. There was improved visceral and renal artery perfusion in 89%: 11% were unchanged. Conclusions The endovascular technique is a safe, efficient and feasible method to repair thoracic aortic lesions. There still remains an appreciable endoleak rate which requires addressing. Covering the LSA is safe in selected patients. The false channel mainly affects renal arteries; SMA is rare. There are many different patterns of damage to visceral arteries. Endovascular repair technique improves the blood supply of the true channel in most cases. Key Words: aorta, aneurysm, dissection, endovascular.