ABSTRACT 108

ENDOVASCULAR STENT-GRAFT TREATMENT FOR DISEASES OF THE DESCENDING THORACIC AORTA

A.S. Bortone, D. D’Agostino, S. Schena, G. Mannatrizio, V. Paradiso, N. Vitale, *G. Dialetto, *M. Cotrufo, L. de Luca Tupputi Schinosa
Divisions of Cardiovascular Surgery, DETO, University of Bari and *Second University of Naples, Italy.

Background.Our experience with results about endovascular stent-graft placement as an alternative to surgical repair for diseases of the descending thoracic aorta is reported.

Methods.From March 1999 to October 2000, a total of 18 patients (17 M and 1 F) underwent endovascular stent-graft placement in the descending thoracic aorta. Three categories of diseases were treated: chronic (n=6) or post-traumatic pesudoaneurysms (n=7) and type B aortic dissections (n=5). A preoperative evaluation was performed in all cases by 5-mm spiral angio-CT scan. The grafts implanted were Talent®-Medtronic (4) and Excluder®-Gore (14).

Results.Despite the number of cases performed,a total of 22 grafts were deployed. Two patients required an additional graft and one case was managed with 3 interposed stents because of dolicoaorta. The placement of the stent grafts was successful in all patients but 1 with a dissection characterized by a large intimal flap blocking the graft insertion. An optimal graft sealing was achieved in 17 patients. Only one case underwent descending aorta replacement because of a calcified false aneurysm still compressing the airway stem. Three patients required a left subclavian-common carotid artery bypass in order to obtain an optimal sealing of the aneurysm neck. No spinal cord injuries were detected and the mean postoperative stay was 7 days. At a follow-up performed after 3 months and 1 year, every patient was healthy and experienced no graft-related complications as confirmed by a chest angio-CT scan.

Conclusions.Managing diseases of descending thoracic aorta by endovascular stent-graft represents a valid and safe therapeutic option.