Results after endovascular stent-graft placement in atherosclerotic aneurysms involving the descending aorta

Aims: To determine durability and need for reinterventions after endovascular stent-graft placement in atherosclerotic aneurysms involving the descending aorta.

Patients and methods: We performed a prospective follow-up analysis of a consecutive series of patients (n=79) undergoing endovascular stent-graft placement due to atherosclerotic aneurysms involving the descending aorta between 1996 and 2006. Acute aortic syndromes were excluded from this analysis. Mean follow-up was 42 months (range, 1–108 months). The following events were collected: In-hospital mortality, occurrence of early and late endoleaks, reintervention due to early and late endoleaks as well as survival.

Results: In-hospital mortality was 6.3% (n=5), two of these patients underwent emergent treatment. Early type I and III endoleaks were observed in 29% of patients (n=23). Assisted primary endoleak rate was 11%. Late type I or III endoleaks occurred in 21% (n=17). Overall actuarial survival was 96%, 86% and 69% at 1, 3 and 5 years, respectively. Event-free survival was 90%, 82% and 65% at 1, 3 and 5 years, respectively. Cox proportional hazard analysis revealed a short proximal landing zone as well as a high number of stent-grafts used as independent risk factors for early and late endoleak formation. Late endoleak formation was an independent predictor of survival.

Conclusions: Durability of endovascular stent-graft placement in atherosclerotic aneurysms involving the descending aorta is satisfying. Extensive gaining of landing zones is a prerequisite of early and late success. Further clinical investigations are warranted to evaluate long-term durability of this attracitve treatment modality.