Subscribe to RSS
DOI: 10.1055/s-0029-1240926
© Georg Thieme Verlag KG Stuttgart · New York
Elective Matsui-Kitamura Stent Graft Repair for Descending Thoracic Aortic Aneurysm and Chronic Type-B Aortic Dissection
Publication History
received October 30, 2009
Publication Date:
02 August 2010 (online)

Abstract
Background: The position of thoracic endovascular aortic repair (TEVAR) compared to open surgery of the thoracic aorta has changed. This study evaluates outcomes after TEVAR performed electively using our original Matsui-Kitamura stent graft (MKSG) to treat descending thoracic aortic aneurysms (dTAA) and chronic type-B aortic dissection (type-B AD), and elucidates the risk factors for postoperative spinal cord ischemia (SCI). Methods: TEVAR was performed using an MKSG in 66 patients (age: 70.8 ± 9.2 years). The underlying etiology was atherosclerotic change in 39 patients, chronic type-B aortic dissection in 23 patients, and other in 4 patients. Results: No perioperative deaths occurred. Three patients showed temporary paralysis due to postoperative SCI. Abdominal aortic aneurysm (AAA) surgery was a risk factor for postoperative SCI (p = 0.04). The 5-year survival rate was 81.2 %. Conclusion: The present study demonstrated that TEVAR of patients with dTAA and chronic type-B AD using an MKSG can be performed with high technical success rates and low rates of severe acute complications. AAA surgery was a risk factor for postoperative SCI.
Key words
descending thoracic aortic aneurysm - Matsui‐Kitamura stent graft - spinal cord ischemia - chronic type‐B aortic dissection
References
- 1 Makaroun M S, Dillavou E D, Kee S T et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg. 2005; 41 1-9
- 2 Khoynezhad A, Donayre C E, Bui H, Kopchok G E, Walot I, White R A. Risk factors for early and late mortality after thoracic endovascular aortic repair. Ann Thorac Surg. 2007; 83 S882-S889
- 3 Sanada J, Matsui O, Terayama N et al. Clinical application of a curved nitinol stent-graft for thoracic aortic aneurysms. J Endovasc Ther. 2003; 10 (1) 20-28
- 4 Ohtake H, Kimura K, Watanabe G, Sanada J, Matsui O. Clinical application of an original flexible MK stent-graft for nonruptured thoracic aortic aneurysms: early experience. Innovations. 2006; 3 119-122
- 5 Cheung A T, Pochettino A, McGarvey A L et al. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg. 2005; 80 1280-1288
- 6 Feezor R J, Lee W A. Strategies for detection and prevention of spinal cord ischemia during TEVAR. Semin Vasc Surg. 2009; 22 187-192
- 7 Bavaria J E, Appoo J J, Makaroun M S et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg. 2007; 133 369-377
- 8 Matsumura J S, Cambria R P, Dake M D et al. International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results. J Vasc Surg. 2008; 47 247-257
- 9 Feezor R J, Martin T D, Hess Jr P J et al. Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair. Ann Thorac Surg. 2008; 86 1809-1814
- 10 Amabile P, Grisoli D, Giorgi R, Bartoli J M, Piquet P. Incidence and determinants of spinal cord ischaemia in stent-graft repair of the thoracic aorta. Eur J Vasc Endovasc Surg. 2008; 35 455-461
- 11 Carroccio A, Ellozy S, Marin M L, Hollier L H. Endovascular thoracic aortic aneurysm repair: proposed mechanism of paraplegia. Gefaesschirurgie. 2003; 8 564-568
- 12 Carroccio A, Marin M L, Ellozy S, Hollier L H. Pathophysiology of paraplegia following endovascular thoracic aortic aneurysm repair. J Card Surg. 2003; 18 359-366
- 13 Böckler D, Kotelis D, Kohlhof P et al. Spinal cord ischemia after endovascular repair of the descending thoracic aorta in a sheep model. Eur J Vasc Endovasc Surg. 2007; 34 461-469
- 14 Kawaharada N, Morishita K, Kurimoto Y et al. Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta. Eur J Cardiothorac Surg. 2007; 31 998-1003
- 15 Fattori R, Nienaber C A, Rousseau H, Beregi J P et al. Results of endovascular repair of the thoracic aorta with the Talent thoracic stent graft: the Talent thoracic retrospective registry. J Thorac Cardiovasc Surg. 2006; 132 332-339
- 16 Schlösser F J, Verhagen H J, Lin P H et al. TEVAR following prior abdominal aortic aneurysm surgery: increased risk of neurological deficit. J Vasc Surg. 2009; 49 308-314
- 17 Griepp R B, Ergin M A, Galla J D, Lansman S et al. Looking for the artery of Adamkiewicz: a quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta. J Thorac Cardiovasc Surg. 1996; 112 1202-1215
Dr. Hiroshi Ohtake, PhD, MD
General & Cardiothoracic Surgery
Kanazawa University
Takara-machi 13-1
9208641 Kanazawa
Japan
Phone: +81 7 62 65 23 55
Fax: +81 7 62 22 68 33
Email: ohtake@med.kanazawa-u.ac.jp