Peripheral Vascular Surgery Society

Thamrongroj Temudom, MD, Michael L. Marin, MD,

Larry H. Hollier, MD, Richard E. Parsons, MD, Harold A. Mitty, MD,

James Cooper, MD, Jiyong Ahn, MD, and Randall Griepp, MD.

Mount Sinai Medical Center, New York, NY

Thoracic aneurysm may pose technical challenges for open repair, particularly in patients with significant medical comorbidities. We describe an experience with balloon-expandable and self-expandable endovascular grafts for the management of thoracic aneurysms to identify technical parameters that may impact on success.

Nine endovascular grafts were implanted in eight patients for the treatment of atherosclerotic aneurysms and pseudoaneurysms. Endovascular procedures were performed using one of three different devices: 1) Balloon-Expandable Palmaz Stent PTFE prosthesis (BE-PS), 2) Self-Expanding Nitinol-Dacron prosthesis (Vanguard SE-V), and 3) Self-Expanding Nitinol PTFE prosthesis (Excluder SE-E).

(1) Technical Success = full exclusion of the aneurysm

The mean age of patients in this study was 57 years. BE-PS required a period of temporary asystole during deployment to prevent device migration, which was not necessary for SE-V and SE-E. Immediate aneurysm exclusion was achieved in six of the nine procedures (66.6%). In two patients, endoleaks discovered after grafting, one of which was repair by the insertion of a second endovascular graft. The other patient whose aneurysm was not successfully excluded, was converted to an open repair, and died postoperatively from cardiac failure.

Endovascular grafting represents a potentially important alternative therapy to open repair of the thoracic aorta. Self-expanding devices which do not require cardiac asystole in order to achieve proper positioning appear to be advantageous. Long-term follow-up of the durability of these devices will be necessary before widespread application of these systems can be advocated.