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Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results.
J Vasc Surg. 2006 Dec; 44(6):1188-97.JV

Abstract

OBJECTIVE

Pivotal and comparative trial data are emerging for stent graft (SG) vs open repair of the thoracic aorta. We reviewed procedure-related perioperative morbidity, mortality, and mid-term outcomes in a contemporary series of patients treated with SG of the thoracic aorta. The data were compared with those of a patient cohort concurrently treated with open surgical repair confined to the descending aorta.

METHODS

A review of patients undergoing SG procedures and open surgery of the thoracic aorta from January 1, 1996, to November 30, 2005, was performed from a prospectively compiled database. Study end points included perioperative complications, late survival, freedom from reinterventions, and graft-related complications. Multivariate methods were used to assess variables potentially associated with study end points; late outcomes were compared with actuarial methods.

RESULTS

In 105 patients (mean age, 70 years; 66 male [62.9%]) SG repairs were done for 68 degenerative aneurysms (64.7%), 12 penetrating ulcers (11.4%), 15 pseudoaneurysms (14.3%), 9 traumatic tears (8.6%), and 1 acute dissection (0.9%). Mean follow-up was 22 months (range, 0 to 101 months). Eighty-nine (84.8%) SG patients were asymptomatic at presentation and underwent elective repair, whereas 16 (15.2%) presented with acute conditions and underwent urgent repair. Perioperative mortality was 7.6% (8/105), and actuarial survival at 48 months was 54% +/- 7%. The perioperative mortality rate among SG patients treated for degenerative pathology was 10.4% (8/77). Seven (6.7%) of 105 patients experienced spinal cord ischemic complications, including 2 patients with transient paraparesis that resolved by the time of discharge. Reinterventions were performed in 10.5% of patients (11/105), with freedom from reintervention approaching 81% by 48 months. Over the same interval, 93 patients were treated with open-surgical repair for descending thoracic aneurysm (anastomosis cephalad to the celiac axis). Perioperative mortality in the open cohort was 15.1% (14/93; P = .09 vs SG repair), and the 48-month actuarial survival was 64% +/- 6%. The incidence of spinal cord ischemic complications was 8.6% (8/93), including 4 patients with transient paraparesis (P = .44 vs SG repair). Nine patients (9.7%) required surgical reintervention during the follow-up period, with 48-month freedom from reintervention approaching 79% (P = .73 vs SG repair).

CONCLUSIONS

Operative mortality was halved with SG, with similar late survival for both cohorts. Reinterventions were required at a nearly identical rate for open repair and SG, and both groups experienced similar rates of spinal cord ischemic complications.

Authors+Show Affiliations

Division of Vascular and Endovascular Surgery and the Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17145420

Citation

Stone, David H., et al. "Stent-graft Versus Open-surgical Repair of the Thoracic Aorta: Mid-term Results." Journal of Vascular Surgery, vol. 44, no. 6, 2006, pp. 1188-97.
Stone DH, Brewster DC, Kwolek CJ, et al. Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg. 2006;44(6):1188-97.
Stone, D. H., Brewster, D. C., Kwolek, C. J., Lamuraglia, G. M., Conrad, M. F., Chung, T. K., & Cambria, R. P. (2006). Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. Journal of Vascular Surgery, 44(6), 1188-97.
Stone DH, et al. Stent-graft Versus Open-surgical Repair of the Thoracic Aorta: Mid-term Results. J Vasc Surg. 2006;44(6):1188-97. PubMed PMID: 17145420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. AU - Stone,David H, AU - Brewster,David C, AU - Kwolek,Christopher J, AU - Lamuraglia,Glenn M, AU - Conrad,Mark F, AU - Chung,Thomas K, AU - Cambria,Richard P, PY - 2006/05/11/received PY - 2006/08/01/accepted PY - 2006/12/6/pubmed PY - 2007/1/20/medline PY - 2006/12/6/entrez SP - 1188 EP - 97 JF - Journal of vascular surgery JO - J Vasc Surg VL - 44 IS - 6 N2 - OBJECTIVE: Pivotal and comparative trial data are emerging for stent graft (SG) vs open repair of the thoracic aorta. We reviewed procedure-related perioperative morbidity, mortality, and mid-term outcomes in a contemporary series of patients treated with SG of the thoracic aorta. The data were compared with those of a patient cohort concurrently treated with open surgical repair confined to the descending aorta. METHODS: A review of patients undergoing SG procedures and open surgery of the thoracic aorta from January 1, 1996, to November 30, 2005, was performed from a prospectively compiled database. Study end points included perioperative complications, late survival, freedom from reinterventions, and graft-related complications. Multivariate methods were used to assess variables potentially associated with study end points; late outcomes were compared with actuarial methods. RESULTS: In 105 patients (mean age, 70 years; 66 male [62.9%]) SG repairs were done for 68 degenerative aneurysms (64.7%), 12 penetrating ulcers (11.4%), 15 pseudoaneurysms (14.3%), 9 traumatic tears (8.6%), and 1 acute dissection (0.9%). Mean follow-up was 22 months (range, 0 to 101 months). Eighty-nine (84.8%) SG patients were asymptomatic at presentation and underwent elective repair, whereas 16 (15.2%) presented with acute conditions and underwent urgent repair. Perioperative mortality was 7.6% (8/105), and actuarial survival at 48 months was 54% +/- 7%. The perioperative mortality rate among SG patients treated for degenerative pathology was 10.4% (8/77). Seven (6.7%) of 105 patients experienced spinal cord ischemic complications, including 2 patients with transient paraparesis that resolved by the time of discharge. Reinterventions were performed in 10.5% of patients (11/105), with freedom from reintervention approaching 81% by 48 months. Over the same interval, 93 patients were treated with open-surgical repair for descending thoracic aneurysm (anastomosis cephalad to the celiac axis). Perioperative mortality in the open cohort was 15.1% (14/93; P = .09 vs SG repair), and the 48-month actuarial survival was 64% +/- 6%. The incidence of spinal cord ischemic complications was 8.6% (8/93), including 4 patients with transient paraparesis (P = .44 vs SG repair). Nine patients (9.7%) required surgical reintervention during the follow-up period, with 48-month freedom from reintervention approaching 79% (P = .73 vs SG repair). CONCLUSIONS: Operative mortality was halved with SG, with similar late survival for both cohorts. Reinterventions were required at a nearly identical rate for open repair and SG, and both groups experienced similar rates of spinal cord ischemic complications. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/17145420/Stent_graft_versus_open_surgical_repair_of_the_thoracic_aorta:_mid_term_results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01383-8 DB - PRIME DP - Unbound Medicine ER -