Endovascular treatment of descending thoracic aneurysms

Introduction: Current strategies for repair of descending thoracic aortic aneurysms consist of open repair
with surgical graft replacement or thoracic endovascular aortic repair. We review and update our overall experience
in aortic thoracic diseases and specifically analyzed our outcomes with thoracic endovascular aortic repair
in patients with descending thoracic aortic aneurysms.
Methods: From 1993 to present a total of 1144 patients were treated in our Center for pathology involving the
thoracic aorta. Since 1998, 322 patients underwent thoracic endovascular aortic repair, and among this group,
in 188 cases the descending aorta was involved. In 74% of patients treated for a descending thoracic aortic lesion,
a degenerative aneurysm was observed.
Results: In patients with descending thoracic aortic aneurysms receiving thoracic endovascular aortic repair,
our technical success rate, i.e. deployment of endograft with complete exclusion of the lesion/minimal endoleak,
was 99.5% (one case required emergent open conversion) with a perioperative mortality of 2.6% (five
patients). The rate of spinal cord ischemia, manifesting either as paraplegia or paraparesis, was 4.7%. Delayed
onset spinal cord ischemia ameliorated with adequate arterial pressure and cerebrospinal fluid drainage.
Conclusions: Our experience of selected patients undergoing thoracic endovascular aortic repair of descending
thoracic aorta aneurysms is satisfactory with very low mortality and morbidity. A large use of thoracic
endovascular aortic repair is foreseen in the next future.