Device-specific outcomes with endografts for thoracic aortic aneurysms

For the endovascular therapy of abdominal aortic aneurysm an increasing number of publications deal with the subject of device-related outcome and aneurysm sac behaviour. The present study was designed to investigate whether, and to what extent, aneurysm sac behaviour of thoracic aortic aneurysms and perioperative outcome is influenced by the different types of stent grafts. Bibliographic search and analysis was performed. A systematic MEDLINE search on thoracic aortic aneurysms produced a total of 2,884 references with abstracts between 1990 and 2004. Restricted by using the additional terms of 'descending' and 'stent graft' the result condensed to 152 papers. Each reference was analyzed according to predetermined criteria. The majority of articles were published in the English language. Two publications summarized the results of nation-wide or continental registers of endoluminally treated patients with descending aortic dissections or thoracic aortic disease. Several series were partial and/or updated reports from the same authors and/or on the same patients. A total of 48 centres reported about the endovascular treatment of more than 3,000 patients with pathological thoracic aortic entities (Approximately 1,650 degenerative thoracic aortic aneurysms, Approximately 1,000 aortic dissections, Approximately 400 miscellaneous aortic pathologies). The heterogeneity among the series precluded any relevant comparison. Only 4 centres have presented study groups of more than 100 treated patients, but 3 series contained several treated aortic pathologies. Without a differentiation to the underlying pathology, the bibliographic research documented a rate of technical success in a range of 76% to 100%. Summarizing the data of par-procedural and in-hospital mortality the bibliographic research documented a mortality rate of 6.8% for all reported procedures. The rate of paraplegia for all procedures was 1.7%. In conclusion the presented bibliographic search and analysis demonstrated the technical feasibility of the endoluminal stent grafting of a great variety of thoracic aortic pathologies. The short-term results are promising, but data of mid-term results are rare and long-term results are missing. Moreover, the question about the influence of different types of stent grafts on the outcome can not be answered.