Abstract 3053: Endovascular Stent-grafting Can Be Considered As An Initial Management For Thoracic Aortic Emergency
Objective: Emergency descending thoracic aortic graft replacement is often too invasive for critical patients with co-morbidities. We propose that endovascular stent-grafting is appropriate as an initial management for descending thoracic aortic emergency.
Methods: Since 2001, we have performed 230 thoracic aortic stent-grafting procedures using hand-made stent grafts. Among those, 58 patients (25.2%) underwent stent-grafting for thoracic aortic emergency, which is the subject of this study. Early and mid-term results of emergency thoracic aortic stent-grafting were evaluated.
Results: The patients had a mean age of 67.8 years (29 –92), and consisted of 39 males (67.2%). Etiologies of thoracic aortic emergency were a ruptured degenerative aortic aneurysm in 22 (37.9%), a blunt aortic injury in 16, a ruptured aortic dissection in 8, a ruptured anastomotic pseudoaneurysm in 7, a visceral ischemia secondary to acute aortic dissection in 3, and an impending rupture of inflammatory aneurysm in 2. Over-all early mortality rate was 13.8%. Aorta-related early mortality rate was 8.6%, excluding 3 patients who died due to preoperatively associated brain injuries or sepsis. The causes of aorta-related early death were recurrence of hemoptysis in 2, bleeding in 1, cardiac failure in 1, and unknown sudden death in 1. The survival rate and aorta-related event (open conversion, re-stent-grafting, aortic rupture, aortic dissection and unknown sudden death) free rate of 50 discharged patients at 3 years after stent-grafting were 80.7% and 88.7%. The elderly patients (n=32) aged more than 65 years showed a worse survival curve trend compared with non-elderly patients (n=18)(p=0.077). However, aorta-related event free curves of both groups showed no difference (p=0.881).
Conclusion: Endovascular aortic stent-grafting is most appropriate for thoracic aortic emergency, if anatomically feasible. It is particularly useful for elderly patients, as evidenced by this study which showed that their mid-term mortalities were mostly caused by non-aorta-related co-morbidities. Although the early and mid-term results of non-elderly patients following emergency thoracic aortic stent-grafting were also satisfactory, a long-term follow-up is still necessary.