Endovascular treatment of thoracic aorta aneurysms and type B dissections

Aim. For some years, endovascular treatment for aneurysms of the descending thoracic aorta and for type B dissections has been proposed as a less invasive alternative to traditional surgery. Our 3-year initial experience using endografts to treat this disease is described. Methods. Between 1999 and 2002 we treated 24 patients (17 men, 7 women; mean age 67.3 y) through the endovascular approach. The series comprises 13 aneurysms of the descending aorta, 4 aneurysms of the distal arch, 1 acute type B dissection, 3 chronic type B dissections, 2 penetrating ulcers, 1 pseudo-aneurysm of the isthmus. In 8 patients a combined surgical operation was performed for: synchronous disease, occlusive arterial disease, inadequate proximal collar. Results. In all cases the endograft was implanted, with successful primary technique in 96% (23/24 cases). In no case was conversion to surgery necessary. There was 1 case of type 1 proximal endoleak in a patient with aneurysm of the distal arch, which resolved spontaneously 3 months after the procedure. Four primary endoleaks were treated successfully by additional endograft or proximal cuff. Two patients treated for dissecting thoracic aneurysm (type B) developed retrograde perfusion of the false lumen: 1 patient, alive at 15-mo follow-up, developed an increased maximum diameter of the aneurysm <5 mm; the 2nd patient died 3 mo after the procedure, probably due to evolution of the aortic disease. One patient died in the immediate postoperative period, presumably due to migration of the endograft. Conclusion. Treatment through endograft is a valid alternative even for complex diseases such as aneurysm of the aortic arch. The long-term efficacy of this technique is still to be evaluated through controlled studies on a significant number of patients.