Branched Stent-Grafts Preferred to Open Vascular Surgery

A modular stent-graft that incorporates multiple caudally-directed branches to the visceral arteries can offer a safer surgical alternative to open repair for thoracoabdominal aortic aneurysm (TAAA), according to a new study.

University of California San Francisco (UCSF; USA) researchers reported the results of surgery in 16 patients (all unfit for open repair) who were successfully treated with self-expanding covered stents connecting the caudally-directed cuffs of an aortic stent-graft with the visceral branches of an aortic aneurysm (57 branches in all). The technique employed "springy” grafts with overlapping segments where the components meet; the branches of the stent-graft curve downwards and outwards from the main trunk, mimicking the branching pattern of a normal thoracoabdominal aorta. The customized aortic stent-grafts were inserted through the femoral or iliac arteries, while covered stents were inserted through the brachial arteries. Routine follow-up included contrast-enhanced computed tomography (CT) scans at one week, one month, six months, and one year.

The results showed that four patients had significant perioperative complications during follow-up (mean 180 days). Two with severe longstanding chronic obstructive pulmonary disease developed pneumonia; one developed paraplegia and renal failure and died after declining dialysis; and one underwent successful re-intervention for iatrogenic aortic dissection and for type 1 endoleak. There were no other cases of death, re-intervention, endoleak, stroke, or myocardial infarction. According to the researchers, the overall rate of perioperative death, paraplegia, stroke, or renal failure was 5% and no stent-graft had moved, leaked, came apart, kinked, occluded, or broke during follow-up. The study was presented at the 61st annual meeting of the Society for Vascular Surgery, held during June 2007 in Chicago, IL, USA.

"Open repair is difficult because the TAAA is inaccessible and also is dangerous because the operation requires a large incision and extensive dissection,” said lead author Timothy A.M. Chuter, M.D., a professor of surgery in residence in the division of vascular surgery at UCSF. "Additionally, with open repair, there is an interruption of blood flow to the lower half of the body, including abdominal organs.”

Dr. Chuter added that the less invasive approach eliminates aneurysm flow, while at the same time preserving visceral perfusion and avoiding the main physiologic stresses.


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