Extended Applications of Thoracic Aortic Stent Grafts

Background Thoracic stent-grafts (TSG) show excellent early and mid-term results for localized diseases of the descending aorta. Extending TSG applications for arch pathologies or to other yet unproven indications remains to be established. We herein report our experience in 18 patients with extended applications of TSG. Methods Ten patients with inadequate proximal aortic neck length required coverage of at least one arch vessel with or without extra-anatomic bypass. One patient required an extra-anatomic visceral bypass to extend the distal aortic neck, 6 patients were treated with TSG for yet unproven indications, and 1 patient required an unusual vascular access. Results A mean of 2.4 ± 1.0 stents per patient were inserted. Primary or secondary success rate was 100%. Hospital mortality occurred in one patient (5.5%). Mean follow-up was 24.1 ± 13.7 months. Four endoleaks were diagnosed: two of type 1, one of type 2, and one that remains undetermined. Two patients died during follow-up; both deaths were linked to the presence of a type 1 endoleak. Actuarial survival at 3 years was 79.0%. Freedom from endoleak and stent-graft-related death at 3 years were, respectively, 71.0% and 83.7%. No stent-graft migration was observed. Conclusions Early and mid-term results of extended applications of TSG are acceptable in well-selected high-risk patients. Endoleak at follow-up remains a concern and may impede long-term outcome of TSG in complex procedures.