Thorac Cardiovasc Surg 2010; 58(5): 265-270
DOI: 10.1055/s-0029-1240926
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Elective Matsui-Kitamura Stent Graft Repair for Descending Thoracic Aortic Aneurysm and Chronic Type-B Aortic Dissection

H. Ohtake1 , J. Sanada2 , K. Kimura1 , O. Matsui2 , G. Watanabe1
  • 1General & Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
  • 2Radiology, Kanazawa University, Kanazawa, Japan
Further Information

Publication History

received October 30, 2009

Publication Date:
02 August 2010 (online)

Abstract

Background: The position of thoracic endovascular aortic repair (TEVAR) compared to open surgery of the thoracic aorta has changed. This study evaluates outcomes after TEVAR performed electively using our original Matsui-Kitamura stent graft (MKSG) to treat descending thoracic aortic aneurysms (dTAA) and chronic type-B aortic dissection (type-B AD), and elucidates the risk factors for postoperative spinal cord ischemia (SCI). Methods: TEVAR was performed using an MKSG in 66 patients (age: 70.8 ± 9.2 years). The underlying etiology was atherosclerotic change in 39 patients, chronic type-B aortic dissection in 23 patients, and other in 4 patients. Results: No perioperative deaths occurred. Three patients showed temporary paralysis due to postoperative SCI. Abdominal aortic aneurysm (AAA) surgery was a risk factor for postoperative SCI (p = 0.04). The 5-year survival rate was 81.2 %. Conclusion: The present study demonstrated that TEVAR of patients with dTAA and chronic type-B AD using an MKSG can be performed with high technical success rates and low rates of severe acute complications. AAA surgery was a risk factor for postoperative SCI.

References

  • 1 Makaroun M S, Dillavou E D, Kee S T et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis.  J Vasc Surg. 2005;  41 1-9
  • 2 Khoynezhad A, Donayre C E, Bui H, Kopchok G E, Walot I, White R A. Risk factors for early and late mortality after thoracic endovascular aortic repair.  Ann Thorac Surg. 2007;  83 S882-S889
  • 3 Sanada J, Matsui O, Terayama N et al. Clinical application of a curved nitinol stent-graft for thoracic aortic aneurysms.  J Endovasc Ther. 2003;  10 (1) 20-28
  • 4 Ohtake H, Kimura K, Watanabe G, Sanada J, Matsui O. Clinical application of an original flexible MK stent-graft for nonruptured thoracic aortic aneurysms: early experience.  Innovations. 2006;  3 119-122
  • 5 Cheung A T, Pochettino A, McGarvey A L et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms.  Ann Thorac Surg. 2005;  80 1280-1288
  • 6 Feezor R J, Lee W A. Strategies for detection and prevention of spinal cord ischemia during TEVAR.  Semin Vasc Surg. 2009;  22 187-192
  • 7 Bavaria J E, Appoo J J, Makaroun M S et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial.  J Thorac Cardiovasc Surg. 2007;  133 369-377
  • 8 Matsumura J S, Cambria R P, Dake M D et al. International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results.  J Vasc Surg. 2008;  47 247-257
  • 9 Feezor R J, Martin T D, Hess Jr P J et al. Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair.  Ann Thorac Surg. 2008;  86 1809-1814
  • 10 Amabile P, Grisoli D, Giorgi R, Bartoli J M, Piquet P. Incidence and determinants of spinal cord ischaemia in stent-graft repair of the thoracic aorta.  Eur J Vasc Endovasc Surg. 2008;  35 455-461
  • 11 Carroccio A, Ellozy S, Marin M L, Hollier L H. Endovascular thoracic aortic aneurysm repair: proposed mechanism of paraplegia.  Gefaesschirurgie. 2003;  8 564-568
  • 12 Carroccio A, Marin M L, Ellozy S, Hollier L H. Pathophysiology of paraplegia following endovascular thoracic aortic aneurysm repair.  J Card Surg. 2003;  18 359-366
  • 13 Böckler D, Kotelis D, Kohlhof P et al. Spinal cord ischemia after endovascular repair of the descending thoracic aorta in a sheep model.  Eur J Vasc Endovasc Surg. 2007;  34 461-469
  • 14 Kawaharada N, Morishita K, Kurimoto Y et al. Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta.  Eur J Cardiothorac Surg. 2007;  31 998-1003
  • 15 Fattori R, Nienaber C A, Rousseau H, Beregi J P et al. Results of endovascular repair of the thoracic aorta with the Talent thoracic stent graft: the Talent thoracic retrospective registry.  J Thorac Cardiovasc Surg. 2006;  132 332-339
  • 16 Schlösser F J, Verhagen H J, Lin P H et al. TEVAR following prior abdominal aortic aneurysm surgery: increased risk of neurological deficit.  J Vasc Surg. 2009;  49 308-314
  • 17 Griepp R B, Ergin M A, Galla J D, Lansman S et al. Looking for the artery of Adamkiewicz: a quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta.  J Thorac Cardiovasc Surg. 1996;  112 1202-1215

Dr. Hiroshi Ohtake, PhD, MD

General & Cardiothoracic Surgery
Kanazawa University

Takara-machi 13-1

9208641 Kanazawa

Japan

Phone: +81 7 62 65 23 55

Fax: +81 7 62 22 68 33

Email: ohtake@med.kanazawa-u.ac.jp

    >