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Endovascular stent graft repair of abdominal and thoracic aortic aneurysms: a ten-year experience with 817 patients.

Abstract：

OBJECTIVE:On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. SUMMARY AND BACKGROUND DATA:Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality. METHODS:Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed. RESULTS:The mean age was 74.3 years (range, 25-95 years); 678 patients (83%) were men; 86% had 2 or more comorbid medical illnesses, 67% of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8% of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 +/- 6% at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 +/- 1% at 9 years. There was a 2.3% incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months. CONCLUSIONS:Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Marin ML,Hollier LH,Ellozy SH,Spielvogel D,Mitty H,Griepp R,Lookstein RA,Carroccio A,Morrissey NJ,Teodorescu VJ,Jacobs TS,Minor ME,Sheahan CM,Chae K,Oak J,Cha A

doi

10.1097/01.sla.0000090473.63393.e9

subject

Has Abstract

pub_date

2003-10-01 00:00:00

pages

586-93; discussion 593-5

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-200310000-00014

journal_volume

238

pub_type

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Endovascular stent graft repair of abdominal and thoracic aortic aneurysms: a ten-year experience with 817 patients.