Abstract 3538: Fenestrated Stent-graft Placement Can be an Alternative Management for Distal Aortic Arch Disease
PURPOSE Endovascular stent-graft placement (SG) has commonly been employed as a less-invasive treatment for descending thoracic aortic disease. However, conventional SG cannot provide favorable results for distal aortic disease because of short proximal neck. We report that SG using a fenestrated stent graft which allows us to use the aortic arch as a proximal landing zone without obstruction of brain circulation can be an alternative management for distal aortic disease.
METHODS Between the periods of January 2002 and April 2006, 394 patients with thoracic aortic disease were surgically treated in our university hospital. Among them, 82 patients (20.8%) with distal aortic disease are the subjects of this study. Distal aortic disease was defined as disease which should be repaired by aortic clamping more proximal to the left subclavian artery if using aortic clamping technique in a case of open repair through left thoracotomy. Fifty-six patients who had considerable preoperative co-morbidities underwent SG using hand-made fenestrated (n=41) or non-fenestrated (n=15) stent grafts (SG group). The other 26 patients underwent open surgical graft-replacement under cardio-pulmonary bypass (OS group). Emergency operation rates of SG group and OS group were 21.4% and 11.5% (p=0.281) respectively. SG group consisted of many high-risk patients who were referred from local hospitals where cardio-vascular surgery has routinely been performed (28 cases, 50.0%), compared with OS group (4 cases, 15.4%) (p=0.003).
RESULTS Early mortality rates of SG group and OS group were 5.4% and 11.5% (p=0.194). Post-operative complication free rates of SG group and OS group were 79.5% and 52.2% (p=0.020) respectively. Actual survival rates and aorta-related event (re-SG, open surgery, aortic dissection and aortic rupture) free rates in the 3 years after operation of SG group and Open group were 64.5% and 71.8% (p=0.747), and 77.8% and 95.2% (p=0.078), respectively.
CONCLUSION SG using a fenestrated stent graft was helpful for high-risk patients with distal aortic disease. However, considering the greater incidence of SG-related events in the follow-up periods, in the current situation it is recommended that risk-free patients undergo conventional open surgery.