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Endovascular Stent-Graft Treatment of Thoracic Aortic Disease¹

¹ From the Departments of Radiology (G.G., M.F.V., M.M., I.A., F.Y.) and Vascular Surgery (L.R.), Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received February 28, 2005; revision requested March 30 and received May 16; accepted May 23. The authors discuss an investigational or unlabeled use of a commercial product, device, or pharmaceutical that has not been approved for such purpose by the FDA. All authors have no financial relationships to disclose. Address correspondence to G.G. (e-mail: gmoll{at}eresmas.com).

Aneurysmal diseases of the thoracic aorta are life-threatening conditions. In such cases, stent-graft treatment has been proposed as an alternative to surgery. The morbidity and mortality associated with endovascular repair are significantly lower than those associated with open surgery. In the largest surgical series, the mortality ranged from 5% to 20%. In studies of endovascular repair, the 30-day mortality was 0%–20% and the periprocedural stroke rate was 0%–7%. Often, open surgery is prohibited in patients with these high-risk lesions; thus, in many cases endovascular treatment is the only alternative. Thoracic aortic diseases that can be treated with endovascular stent-graft placement include aneurysms, dissection, traumatic rupture, traumatic pseudoaneurysms, intramural hematoma, penetrating atherosclerotic ulcers, and aortic rupture. Thorough preprocedure imaging is essential for selecting patients, choosing the stent-graft devices, and planning the intervention. Prerequisites for endovascular stent-graft placement are an adequate neck for graft attachment and adequate vascular access. When the ascending aorta or aortic arch is involved, surgical and endovascular procedures can be combined and performed simultaneously, allowing treatment of a wider range of cases. An experienced interdisciplinary team is needed to manage such cases.

© RSNA, 2005