Endovascular Repair for Thoracic Aortic Disease: A Viable Alternative
A new study in the April issue of the Journal of Vascular Surgery reveals that use of minimally invasive endovascular stent grafts for the treatment of thoracic aortic disease is a viable alternative for patients who might not be able to survive open surgery.
"Traditional, open surgical management of thoracic aortic disease is a high risk surgery, especially when we treat the very elderly or patients with other pre-existing illnesses," said co-author of the study Mark D. Morasch, MD. "New, minimally invasive endovascular techniques that use stent-grafts to treat these aortic problems have been developed as alternatives to these highly morbid open operations."
Dr. Morasch is an attending vascular surgeon at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital, co-director of the Bluhm Cardiovascular Institute's Thoracic Aortic Surgery Program, and associate professor at Northwestern University's Feinberg School of Medicine.
In this study, the authors reviewed the early and mid-term results of these minimally invasive procedures in a high risk group of patients who were treated at one academic medical center.
One hundred fifteen patients were followed after treatment of a number of different types of aortic diseases including aneurysms, vessel tears from trauma, intramural hematomas and dissections. The patients were followed closely for an average of 15 months (range 1 to 78 months) after the endograft was placed. Thirty-five percent of the endografts were placed under emergent circumstances, including aneurysm rupture or acute aortic tear, where open surgery is known to be extremely risky. In 24 percent of the cases, one or more major aortic branch had to be moved or bypassed with an additional small operation prior to delivering the endograft to prevent compromise to important circulation.
Five percent of the patients treated in this study died following surgery, which compares very favorably with historic results from similar high-risk patients who undergo an open operation. Despite the minimally invasive nature of the procedure, many patients still had some type of complication related to the treatment and in a few cases, repeat treatments were required to keep the patients safe.
"These advances in endovascular technology have allowed many patients to undergo much-needed life saving procedures who otherwise may not have survived treatment," said Morasch. "On the other hand, some elderly and infirmed may not fare well even with a 'minimally invasive' therapy."
Morasch added, "Unlike with open surgical repair, the long term durability of these minimally invasive therapies remains to be seen making long-term imaging surveillance necessary to monitor for a need for repeat intervention. Overall, the use of endografts for the treatment of thoracic aortic pathology is safe, effective and clearly a positive step forward but it does still carry risk in the complex patient population who come for endovascular repair."