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Endovascular Stent Grafting of Descending Thoracic Aortic Aneurysms^*

^* From the Divisions of Cardiology (Drs. Gowda and Misra) and Cardiothoracic Surgery (Dr. Tranbaugh), Beth Israel Medical Center, New York, NY; Division of Vascular Surgery (Dr. Ohki), Montefiore Medical Center, Bronx, NY; and Division of Cardiology (Dr. Khan), Creighton University School of Medicine, Omaha, NE.

Correspondence to: Ijaz A. Khan, MD, FCCP, Creighton University Cardiac Center, 3006 Webster St, Omaha, NE 68131; e-mail: ikhan{at}cardiac.creighton.edu

The treatment of descending thoracic aortic aneurysms using endovascular stents is one of the more recent advances in treatment and is receiving increasing attention as it is a less invasive alternative to open surgical repair. Although the technology is still primitive, significant improvements have lately been made in the design and deployment of the endovascular stent-grafts. Aortic stent-grafts were used initially to exclude abdominal, and later thoracic, aortic true and false aneurysms. These prostheses have been increasingly used to treat aneurysms, dissections, and traumatic ruptures of the descending thoracic aorta with good early and mid-term outcomes. Although the long-term outcome of patients with aneurysms of the descending thoracic aorta after stent graft implantation has not been investigated, continued refinement of the endovascular approaches has decreased the need for conventional open thoracic aortic aneurysm repair, especially in patients who are at a high risk for standard surgery because of advanced age or the presence of comorbid diseases. The placement of endoluminal stent-grafts to exclude the dissected or ruptured site of thoracic aortic aneurysms is a technically feasible and relatively safe procedure. With the rapid development of endovascular approaches, the treatment of the descending thoracic aortic aneurysms might alter even more, but an extended follow-up is necessary to determine the longer term outcome. Historical perspectives, advantages, device considerations, complications, and current perspectives of the endovascular stent grafting of the descending thoracic aortic aneurysms are elaborated on.

Key Words: aortic aneurysms • aortic atherosclerosis • aortic diseases • aortic dissection • endovascular repair • endovascular stent-grafting • stent grafting of aorta

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