Endovascular Stent-Grafts for Descending Thoracic Aortic Aneurysms and Acute Type B Aortic Dissections

  • D. Craig Miller
Conference paper
Part of the Keio University International Symposia for Life Sciences and Medicine book series (KEIO, volume 7)


Because patients with descending thoracic aortic aneurysms tend to be elderly and have multiple other co-morbidities, conventional open surgical repair of these life-threatening thoracic aortic problems is associated with substantial morbidity and mortality. Therefore, the CV Surgery and CVRI teams at Stanford collaborated to conduct a prospective, nonrandomized clinical trial to assess the feasibility and effectiveness of endovascular stent-graft (S-G) repair. Between 1992 and 1997,103 patients (mean age 69 years) underwent treatment using a custom fabricated “home brew” (self-expanding Z stents, large sheath/dilator/pusher rod delivery system) S-G device. Sixty-two patients (60%) were judged not to be reasonable candidates for an “open” operation. Nineteen patients underwent simultaneous AAA repair. Etiology included atherosclerotic-degenerative aneurysm 62%, giant aortic penetrating ulcer (GAPU) 10%, aortic dissection 8%, chronic traumatic false aneurysm 8%, anastomotic pseudoaneurysm 8%, intramural hematoma (IMH) 3%, and mycotic false aneurysm 2%. Follow-up was 100% complete (average = 22 months, max = 5.3 years). Forty-four patients remained alive and at risk two years after the procedure. Femoral access was achieved in 58%, but retroperitoneal access via the abdominal aorta was required in 30%. An AAA was repaired concomitantly in 19 patients. Immediate complications included obstruction of the aortic arch in one patient, S-G misdeployment in 3%, peripheral arterial injury in 4%, and iatrogenic aortic dissection in 1%. Complete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients.


Aortic Dissection Acute Aortic Dissection Acute Type Intramural Hematoma Thoracic Aortic Aneurysm 
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Copyright information

© Springer Japan 2001

Authors and Affiliations

  • D. Craig Miller
    • 1
  1. 1.Department of Cardiovascular SurgeryStanford Unviersity Medical SchoolStanfordUSA

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