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Endovascular Aortic Stent Grafting for Thoracic Diseases: Current Status

Hong Kong China

The first 20% of the full text of this article appears below.

In the past decade, we have witnessed rapid growth in the use of an endovascular aortic stent graft to treat abdominal aortic aneurysms. In many large vascular surgery centers in Asia, the endovascular repair rate for intact aneurysm has already exceeded 50%. Endovascular repair has been widely accepted by patients and surgeons, due to the procedure’s low morbidity and mortality, while randomized studies have confirmed similar midterm efficacy compared to open repair.¹ Long-term durability seems to be less important as many patients are perceived to be at high risk for open surgery, and compromises in anatomical guidelines are often considered acceptable as an alternative to no treatment.

In the thoracic aorta, the advantage of an endograft over open repair is even more apparent, as complex surgery of arch and thoracoabdominal aneurysms often incur large incisions and extracorporeal bypass, with prohibitive risks of hemorrhage, stroke, renal impairment, and paraplegia. Although the long-term durability of thoracic endografting remains relatively unknown, there is evidence from the literature that the early results are at least comparable to those of surgery.² However, for a number of reasons, the development of thoracic stent grafts has lagged behind their abdominal counterparts.

The main constraint in thoracic aortic endografting is the anatomy of the aortic arch. The proximity of the pathology close to the great vessel origins in the arch mandates accurate placement of the graft, yet the considerable hemodynamic forces compounded by the tortuosity of the thoracic aorta and a remote insertion site pose many challenges to deployment. The substantial diameter of the arch and ascending aorta also requires larger devices with big delivery systems, which are often less flexible. The concern of a need for access conduits and iliac artery injuries in Asians with a small stature is without doubt valid, particularly in . . . [Full Text of this Article]