Author(s): Wheatley GH rd, Gurbuz AT, RodriguezLopez JA, Ramaiah VG, Olsen D,
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Abstract BACKGROUND: Despite recent improvements in surgical technique, some patients with descending thoracic aortic pathologies are unable to undergo open surgical repair due to significant comorbidities and/or unfavorable thoracic aortic anatomy. Some of these patients might be able to tolerate a less invasive approach, such as endoluminal grafting. We reviewed our consecutive clinical experience with the Gore TAG endoprosthesis (W. L. Gore & Assoc, Flagstaff, AZ) for the endovascular exclusion of assorted descending thoracic aortic pathologies in higher surgical risk patients. METHODS: After obtaining institutional review board approval, 158 high surgical risk patients underwent attempted delivery of a Gore TAG thoracic endoprosthesis between February 2000 and July 2004. Indications for study enrollment were atherosclerotic aneurysm (n = 76), aortic dissection (n = 36), penetrating aortic ulcer (n = 15), contained rupture (n = 11), pseudoaneurysm (n = 10), traumatic aortic injury (n = 5), aortobronchial fistula (n = 4), and aortic coarctation (n = 1). RESULTS: The device was successfully delivered in 156 (98.7\%) patients. Mean patient age was 72 +/- 12.1 years. Three (1.9\%) patients developed transient paraparesis after graft deployment and 1 (0.6\%) patient developed paraplegia. While postimplantation endoleaks were observed in 18 (11.5\%) patients, only 12 patients required reintervention. Thirty-day mortality was 3.8\% (6 of 156). Mean follow-up was 21.5 +/- 18.8 months, and the overall mortality was 17.3\% (27 of 156). CONCLUSIONS: Endoluminal grafting of multiple types of descending thoracic aorta pathologies with the Gore TAG thoracic endoprosthesis is feasible and safe in higher surgical risk patients. Additional studies and long-term follow-up of these patients are warranted.
This article was published in Ann Thorac Surg
and referenced in Medical & Surgical Urology