Endovascular Treatment of Penetrating Aortic Ulcers: Mid-term Follow-up

• Published in: Revista española de cardiología (English ed.) 2012, Vol.65 (1), p.54-59
• Main Authors: Mestres, Gaspar, Rodríguez, Rubén, García-Madrid, Cesar, Montañà, Xavier, Burrel, Marta, Cruz, Luis Fernando, Flores, Carlos, Riambau, Vicente
• Format: Article
• Language: English
• Subjects: Aneurisma de aorta torácica; Aortic aneurysm; Aortic syndrome; Aortic ulcer; Endovascular; Endovascular procedures; Rotura aórtica; Síndrome aórtico; Thoracic aortic rupture; Úlcera aórtica
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2011.07.019

The aim of this work is to describe the short- and mid-term results of endovascular treatment of penetrating ulcers in the thoracic aorta. Between 1998 and 2010, 22 patients with penetrating ulcers in the thoracic aorta received endografts (mean age 69.8 years, 91% male); 50% were indicated for acute aortic syndrome (8 chest pain, 1 aortic rupture, 1 aortobronchial fistula, 1 distal embolization) and 50% for aortic or ulcer diameter. All preoperative, operative and follow-up data were recorded prospectively and met EUROSTAR criteria. Technical success was 100% with no intraoperative deaths or open conversions; 6 (27.3%) required preoperative supraaortic trunk debranching and 1.3 endografts were used per patient; 27.3% developed complications in-hospital and 9.1% required reintervention prior to discharge. Mortality at 30 days was 4.5%. After a mean 52.3 month follow-up (range 0.1-122), cumulative survival free from complications and reinterventions at 100 months was 61.7% and 79.5% respectively, with 95.5% cumulative survival free from aorta- or procedure-related death. We identified no factors significantly related to poor intra- or postoperative clinical course. Endovascular treatment of penetrating aortic ulcers is both possible and effective despite high patient comorbidity. Although a substantial rate of complications and reinterventions can be expected—especially in-hospital—(38.3% and 20.5% respectively at 100 months), long-term mortality is low (4.5%). Se presentan los resultados a corto y medio plazo del tratamiento endovascular de las úlceras penetrantes de aorta torácica. Entre 1998 y 2010, se trató a 22 pacientes con úlceras penetrantes de aorta torácica mediante endoprótesis (media de edad, 69,8 años; el 91% varones). La indicación se realizó por un síndrome aórtico agudo (el 50%: dolor torácico en 8, rotura en 1, fístula aortobronquial en 1, embolización en 1) o por el diámetro aórtico o de la úlcera (50%). Todos los datos preoperatorios, intraoperatorios y de seguimiento fueron analizados prospectivamente siguiendo el protocolo EUROSTAR. El éxito técnico fue del 100%, sin muertes ni conversiones intraoperatorias; 6 casos (27,3%) requirieron revascularización previa de troncos supraaórticos, y se utilizaron 1,3 dispositivos por paciente; el 27,3% tuvo complicaciones intrahospitalarias, y el 9,1% requirió reintervenciones antes del alta. La mortalidad acumulada a 30 días fue del 4,5%. Tras un seguimiento medio de 52,3 (0,1-122) meses, la super