Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers

• Published in: Journal of vascular surgery 2008-12, Vol.48 (6), p.1361-1368
• Main Authors: Geisbüsch, Philipp, MD, Kotelis, Drosos, MD, Weber, Tim F., MD, Hyhlik-Dürr, Alexander, MD, Kauczor, Hans-Ulrich, MD, PhD, Böckler, Dittmar, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angioscopy - methods; Aorta, Thoracic; Aortic Diseases - diagnosis; Aortic Diseases - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Cardiology. Vascular system; Diseases of the aorta; Female; Follow-Up Studies; Humans; Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Retrospective Studies; Rupture, Spontaneous; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ulcer - diagnosis; Ulcer - surgery; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.07.058

Purpose To present early and midterm results after endovascular stent graft repair of patients with penetrating aortic ulcers (PAU). Methods Between January 1997 and March 2008, a total of 202 patients received thoracic aortic endografting in our institution, 48 patients (32 men, median age 70 years, range, 48-89) with PAU. A retrospective analysis of these patients was performed. Thirty-one patients (65%) showed an acute aortic syndrome (8 contained rupture, 23 symptomatic). Follow-up scheme included postoperative computed tomography angiography prior to discharge, at 3, 6, and 12 months, and yearly thereafter. Mean follow-up was 31.3 months (1.3-112.6). Results Technical success was achieved in 93.7%. Primary clinical success rate was 81.2%. In-hospital mortality was 14.6%. Perioperative mortality was significantly ( P = .036) higher in patients with acute aortic syndrome compared to asymptomatic patients (22.5% vs 0%). Postoperative complications occurred in 15 patients (31%), including 2 patients with minor strokes and 6, respectively, 5 patients with cardiac and/or respiratory complications. Early endoleaks were observed in 9 patients (19%), late endoleaks in another 2 patients. Reintervention was necessary in 4 out of 48 patients (8.4%). The actuarial survival estimates at 1, 3, and 5 years were 78% ± 6%, 74% ± 7%, and 61% ± 10%, respectively. There was no aortic-related death during follow-up. Cox regression showed age (hazard ratio [HR]; 1.08, P = .036) and a maximum aortic diameter >50 mm (HR, 4.92; P = .021) as independent predictors of death. Conclusion Endovascular treatment of penetrating aortic ulcers is associated with a relevant morbidity and mortality rate in frequently highly comorbid patients. Midterm results could prove a sustained treatment success regarding actuarial survival and aortic-related death. Emergencies show a significantly worse outcome, but treatment is still warranted in these symptomatic patients.