Stent-Grafts Repair Aneurysms

Aneurysm of the aorta and dissections, life-threatening conditions that can eventually lead to rupture of the aorta and almost certain death, can now be treated with a minimally invasive procedure, according to a new study.

The study examined an experimental procedure called endovascular thoracic aortic repair (ETAR), which repairs and strengthens the aorta by using fabric tubes called stent-grafts to reinforce weak spots. Seventy-three patients, three-quarters of whom were considered too high-risk to have surgery, underwent an ETAR procedure and were monitored for 12 years. Average survival was nearly four years, and almost half of the patients are still alive today and have not needed additional procedures. About 12% of the patients developed "endoleaks,” in which blood entered the bulging area of the aneurysm despite the presence of the stent-graft. Nine of these patients had an additional procedure to fix the problem. The findings were presented at the annual meeting of the Society of Thoracic Surgeons (STS), held in Chicago (IL, USA) during January 2006.

Since aortic aneurysms and dissections tend to form later in life and are aggravated by factors such as high cholesterol, smoking, and family history, some patients are too high-risk and inherently unlikely to be able to withstand open-chest surgery. For patients over the age of 80, and those who have stiffened arteries (atherosclerosis), diabetes, lung problems, and a history of heart disease or high blood pressure, ETAR may be the only option.

"The minimally invasive approach to major aortic problems promises to revolutionize the way a broad spectrum of patients are treated,” said Himanshu Patel, M.D., the lead author of the STS scientific poster and an assistant professor of cardiac surgery at the University of Michigan Medical School (Ann Arbor, USA). "Even in high-risk patients who would not otherwise be treatable, we see acceptable, encouraging results.”

An estimated 3% of adults over age 65 have some form of aortic aneurysm, and more than 15,000 people in the United States alone die each year from ruptured thoracic aortic aneurysms, dissections, and other problems. Tens of thousands of others may have the conditions but not know it, because aortic problems often do not cause symptoms until they rupture.




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