Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers.

Abstract

To present early and midterm results after endovascular stent graft repair of patients with penetrating aortic ulcers (PAU). Between January 1997 and March 2008, a total of 202 patients received thoracic aortic endografting in our institution, 48 patients (32 men, median age 70 years, range, 48-89) with PAU. A retrospective analysis of these patients was performed. Thirty-one patients (65%) showed an acute aortic syndrome (8 contained rupture, 23 symptomatic). Follow-up scheme included postoperative computed tomography angiography prior to discharge, at 3, 6, and 12 months, and yearly thereafter. Mean follow-up was 31.3 months (1.3-112.6). Technical success was achieved in 93.7%. Primary clinical success rate was 81.2%. In-hospital mortality was 14.6%. Perioperative mortality was significantly (P = .036) higher in patients with acute aortic syndrome compared to asymptomatic patients (22.5% vs 0%). Postoperative complications occurred in 15 patients (31%), including 2 patients with minor strokes and 6, respectively, 5 patients with cardiac and/or respiratory complications. Early endoleaks were observed in 9 patients (19%), late endoleaks in another 2 patients. Reintervention was necessary in 4 out of 48 patients (8.4%). The actuarial survival estimates at 1, 3, and 5 years were 78% +/- 6%, 74% +/- 7%, and 61% +/- 10%, respectively. There was no aortic-related death during follow-up. Cox regression showed age (hazard ratio [HR]; 1.08, P = .036) and a maximum aortic diameter >50 mm (HR, 4.92; P = .021) as independent predictors of death. Endovascular treatment of penetrating aortic ulcers is associated with a relevant morbidity and mortality rate in frequently highly comorbid patients. Midterm results could prove a sustained treatment success regarding actuarial survival and aortic-related death. Emergencies show a significantly worse outcome, but treatment is still warranted in these symptomatic patients.