CardioVascular and Interventional Radiology

, Volume 31, Issue 1, pp 23–35 | Cite as

Long-Term Follow-Up After Endovascular Treatment of Acute Aortic Emergencies

  • M. B. PittonEmail author
  • S. Herber
  • W. Schmiedt
  • A. Neufang
  • B. Dorweiler
  • C. Düber
Clinical Investigation



To investigate the long-term outcome and efficacy of emergency treatment of acute aortic diseases with endovascular stent-grafts.


From September 1995 to April 2007, 37 patients (21 men, 16 women; age 53.9 ± 19.2 years, range 18–85 years) with acute complications of diseases of the descending thoracic aorta were treated by endovascular stent-grafts: traumatic aortic ruptures (n = 9), aortobronchial fistulas due to penetrating ulcer or hematothorax (n = 6), acute type B dissections with aortic wall hematoma, penetration, or ischemia (n = 13), and symptomatic aneurysm of the thoracic aorta (n = 9) with pain, penetration, or rupture. Diagnosis was confirmed by contrast-enhanced CT. Multiplanar reformations were used for measurement of the landing zones of the stent-grafts. Stent-grafts were inserted via femoral or iliac cut-down. Two procedures required aortofemoral bypass grafting prior to stent-grafting due to extensive arteriosclerotic stenosis of the iliac arteries. In this case the bypass graft was used for introduction of the stent-graft.


A total of 46 stent-grafts were implanted: Vanguard/Stentor (n = 4), Talent (n = 31), and Valiant (n = 11). Stent-graft extension was necessary in 7 cases. In 3 cases primary graft extension was done during the initial procedure (in 1 case due to distal migration of the graft during stent release, in 2 cases due to the total length of the aortic aneurysm). In 4 cases secondary graft extensions were performed—for new aortic ulcers at the proximal stent struts (after 5 days) and distal to the graft (after 8 months) and recurrent aortobronchial fistulas 5 months and 9 years after the initial procedure—resulting in a total of 41 endovascular procedures. The 30-day mortality rate was 8% (3 of 37) and the overall follow-up was 29.9 ± 36.6 months (range 0–139 months). All patients with traumatic ruptures demonstrated an immediate sealing of bleeding. Patients with aortobronchial fistulas also demonstrated a satisfactory follow-up despite the necessity for reintervention and graft extension in 3 of 6 cases (50%). Two patients with type B dissection died due to mesenteric ischemia despite sufficient mesenteric blood flow being restored (but too late). Two suffered from neurologic complications, 1 from paraplegia and 1 from cerebral ischemia (probably embolic), 1 from penetrating ulcer, and 1 from persistent ischemia of the kidney. Five of 9 (56%) patients with symptomatic thoracic aneurysm demonstrated endoleaks during follow-up and there was an increase in the aneurysm in 1.


Endovascular treatment is safe and effective for emergency treatment of life-threatening acute thoracic aortic syndromes. Results are encouraging, particularly for traumatic aortic ruptures. However, regular follow-up is mandatory, particularly in the other pathologies, to identify late complications of the stent-graft and to perform appropriate additional corrections as required.


Aortobronchial fistula Endovascular Penetrating aortic ulcer Stent-graft Traumatic aortic rupture Type B aortic dissection 


  1. 1.
    Pate J, Fabian T, Walker W (1995) Acute traumatic rupture of the aortic isthmus: Repair with cardiopulmonary bypass. Ann Thorac Surg 59:90–99PubMedCrossRefGoogle Scholar
  2. 2.
    Cardarelli M, McLaughlin J, Downing S, Brown JM, Attar S, Griffith BP (2002) Management of traumatic aortic rupture: A 30-year experience. Ann Surg 236:465–470PubMedCrossRefGoogle Scholar
  3. 3.
    Ahmad F, Cheshire N, Hamady M (2006) Acute aortic syndrome: Pathology and therapeutic strategies. Postgrad Med J 82:305–312PubMedCrossRefGoogle Scholar
  4. 4.
    Volodos NL, Karpovich IP, Shekhanin VE, Troian VI, Iakovenko LF (1988) A case of distant transfemoral endoprosthesis of the thoracic aorta using a self-fixing synthetic prosthesis in traumatic aneurysm. Grudn Khir 6:84–86PubMedGoogle Scholar
  5. 5.
    Dake MD, Miller DC, Mitchell RS, Semba CP, Moore KA, Sakai T (1998) The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg 116:689–704PubMedCrossRefGoogle Scholar
  6. 6.
    Morrissey NJ, Yano OJ, Soundararajan K, Eisen L, McArthur C, Teodorescu V, Kerstein M, Hollier L, Marin ML (2001) Endovascular repair of paraanastomotic aneurysms of the aorta and the iliac arteries: Preferred treatment for a complex problem. J Vasc Surg 34:503–512PubMedCrossRefGoogle Scholar
  7. 7.
    Nienaber CA, Fattori R, Lund G, Dieckmann C, Wolf W, von Kodolitsch Y, Nicolas V, Pierangeli A (1999) Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 340:1539–1545PubMedCrossRefGoogle Scholar
  8. 8.
    Dake MD, Kato N, Mitchell RS, Semba CP, Ravazi MK, Shimono T, Hirano T, Takeda K, Yada I, Miller DC (1999) Endovascular stent-graft placement for treatment of acute aortic dissection. N Engl J Med 340:1546–1552PubMedCrossRefGoogle Scholar
  9. 9.
    von Oppell UO, Dunne TT, DeGroot MK, Zilla P (1994) Traumatic aortic rupture: Twenty year metaanalysis of mortality and risk of paraplegia. Ann Thorac Surg 58:585–593CrossRefGoogle Scholar
  10. 10.
    von Fricken K, Karamanoukian HL, Ricci M, Taheri A, Bergsland J; Salerno TA (2000) Aortobronchial fistula after endovascular stent graft repair of the thoracic aorta. Ann Thorac Surg 70:1407–1409CrossRefGoogle Scholar
  11. 11.
    von Segesser LK, Genoni M, Kunzli A, Lachat M, Niederhauser U, Vogt P, Schonbeck M, Turina M (1996) Surgery for ruptured thoracic thoraco-abdominal aortic aneurysms. Eur J Cardiothorac Surg 10:996–1001CrossRefGoogle Scholar
  12. 12.
    Düber C, Schmiedt W, Pitton MB, Neufang A, Eberle B, Oelert H, Thelen M (1996) Endovaskuläre Therapie aortaler Aneurysmen: Erste klinische Ergebnisse. Fortschr Röntgenstr 12:55–61CrossRefGoogle Scholar
  13. 13.
    Dorweiler B, Dueber C, Neufang A, Schmiedt W, Pitton MB, Oelert H (2001) Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula. Eur J Cardiothorac Surg 19:739–745PubMedCrossRefGoogle Scholar
  14. 14.
    Pitton MB, Schmiedt W, Neufang A, Herber S, Düber C, Thelen M (2002) Endovaskuläre Behandlung akuter Erkrankungen der thorakalen Aorta. Fortschr Röntgenstr 174:593–599CrossRefGoogle Scholar
  15. 15.
    Pitton MB, Düber C, Neufang A, Schlegel J (2002) Endovascular repair of aortic rupture: Acute non-contained aortic rupture of a penetrating aortic ulcer. Cardiovasc Intervent Radiol 25:64–67PubMedCrossRefGoogle Scholar
  16. 16.
    Baguley CJ, Sibal AK, Alison PM (2005) Repair of injuries to the thoracic aorta and great vessels: Auckland, New Zealand 1995–2004. ANZ J Surg 75:383–387PubMedCrossRefGoogle Scholar
  17. 17.
    Brandt M, Hussel K, Walluscheck KP, Boning A, Rahimi A, Cremer J (2005) Early and long-term results of replacement of the descending aorta. Eur J Vasc Endovasc Surg 30:365–369PubMedCrossRefGoogle Scholar
  18. 18.
    Sayed S, Thompson MM (2005) Endovascular repair of the descending thoracic aorta. Evidence for the change in clinical practice. Vascular 13:148–157PubMedCrossRefGoogle Scholar
  19. 19.
    Rousseau H, Dambrin C, Marcheix B, Richeux L, Mazerolles M, Cron C, Watkinson A, Mugniot A, Soula P, Chabbert V, Canevet G, Roux D, Massabuau P, Meites G, Tran Van T, Otal P (2005) Acute traumatic aortic rupture: A comparison of surgical and stent-graft repair. J Thorac Cardiovasc Surg 129:1050–1055PubMedCrossRefGoogle Scholar
  20. 20.
    Kuhne CA, Ruchholtz S, Voggenreiter G, Eggebrecht H, Paffrath T, Waydhas C, Nastkolb D, AG Polytrauma DGU (2005) Traumatic aortic injuries in severely injured patients. Unfallchirurgie 108:279–287CrossRefGoogle Scholar
  21. 21.
    Hoornweg LL, Dinkelman MK, Goslings JC, Reekers JA, Verhagen HJ, Verhoeven EL, Schurink GW, Balm R (2006) Endovascular management of traumatic ruptures of the thoracic aorta: A retrospective multicenter analysis of 28 cases in The Netherlands. J Vasc Surg 43:1096–1102PubMedCrossRefGoogle Scholar
  22. 22.
    Agostinelli A, Saccani S, Borrello B, Nicolini F, Larini P, Gherli T (2006) Immediate endovascular treatment of blunt aortic injury: Our therapeutic strategy. J Thorac Cardiovasc Surg 131:1053–1057PubMedCrossRefGoogle Scholar
  23. 23.
    Desgranges P, Mialhe C, Cavillon A, Alric P, Ovarfordt P, Kobeiter H, Mathieu D, Melliere D, Becquemin JP (1997) Endovascular repair of posttraumatic thoracic pseudoaneurysm with stent graft. AJR Am J Roentgenol 169:1743–1745PubMedGoogle Scholar
  24. 24.
    Kato N, Dake MD, Miller DC, Semba CP, Mitchell RS, Razavi MK, Kee ST (1997) Traumatic thoracic aortic aneurysm: Treatment with endovascular stent-grafts. Radiology 205:657–662PubMedGoogle Scholar
  25. 25.
    Cowley RA, Turney SZ, Hankins JR, Rodriguez A, Attar S, Ahankar BS (1990) Rupture of thoracic aorta caused by blunt chest trauma: A fifteen-year experience. J Thorac Cardiovasc Surg 100:652–661PubMedGoogle Scholar
  26. 26.
    Kipfer B, Leupi F, Schuepbach P, Friedli D, Althaus U (1994) Acute traumatic rupture. Eur J Cardiothorac Surg 8:30–33PubMedCrossRefGoogle Scholar
  27. 27.
    Lawlor DK, Ott M, Forbes TL, Kribs S, Harris KA, DeRose G (2005) Endovascular management of traumatic thoracic aortic injuries. Can J Surg 48:293–297PubMedGoogle Scholar
  28. 28.
    Michelet P, Roch A, Amabile P, Perrin G, Fulachier V, Piguet P, Auffray JP (2005) Endovascular treatment of isthmic aortic rupture: Use of second generation stent grafts. Ann Fr Anesth Reanim 24:355–360PubMedGoogle Scholar
  29. 29.
    Attia C, Villard J, Boussel L, Farhat F, Robin J, Revel D, Douek P (2007) Endovascular repair of localized pathological lesions of the descending thoracic aorta: Midterm results. Cardiovasc Intervent Radiol May 13 (Epub ahead of print)Google Scholar
  30. 30.
    Saratzis NA, Saratzis AN, Melas N, Ginigs G, Lioupis A, Lykopoulos D, Lazaridis J, Dimitrios K (2007) Endovascular repair of traumatic rupture of the thoracic aorta: Single-center experience. Cardiovasc Intervent Radiol 30:370–375PubMedCrossRefGoogle Scholar
  31. 31.
    Neuhauser B, Czermak B, Jaschke W, Waldenberger P, Fraedrich G, Perkmann R (2004) Stent-graft repair for acute traumatic thoracic aortic rupture. Ann Surg 70:1039–1044Google Scholar
  32. 32.
    Amabile P, Rollet G, Vidal V, Collart F, Bartoli JM, Piquet P (2006) Emergency treatment of acute rupture of the descending thoracic aorta using endovascular stent-grafts. Ann Vasc Surg 20:723–730PubMedCrossRefGoogle Scholar
  33. 33.
    Eggebrecht H, Herold U, Schmermund A, Lind AY, Kuhnt O, Martini S, Kuhl H, Kienbaum P, Peters J, Jakob H, Erbel R, Baumgart D (2006) Endovascular stent-graft treatment of penetrating aortic ulcer: Results over a median follow-up of 27 months. Am Heart J 151:530–536PubMedCrossRefGoogle Scholar
  34. 34.
    Sharzaglia P, Lovato L, Buttazzi K, Russo V, Renzulli M, La Palombara C, Fattori R (2006) Interventional techniques in the treatment of aortic dissection. Radiol Med (Torino) 111:585–596CrossRefGoogle Scholar
  35. 35.
    Winnerkvist A, Lockowandt U, Rasmussen E, Radegran K (2006) A prospective study of medically treated acute Type B aortic dissection. Eur J Vasc Endovasc Surg 32:349–355PubMedCrossRefGoogle Scholar
  36. 36.
    Gaxotte V, Thony F, Rousseau H, Lions C, Otal P, Willoteaux S, Rodiere M, Negaiwi Z, Joffre F, Beregi JP (2006) Midterm results of aortic diameter outcomes after thoracic stent graft implantation for aortic dissection: A multicenter study. J Endovasc Ther 13:127–138PubMedCrossRefGoogle Scholar
  37. 37.
    Neuhauser B, Czermak BV, Fish J, Perkmann R, Jaschke W, Chemelli A, Fraedrich G (2005) Type A dissection following endovascular thoracic aortic stent-graft repair. J Endovasc Ther 12:74–81PubMedCrossRefGoogle Scholar
  38. 38.
    Dias NV, Sonesson B, Koul B, Malina M, Ivancev K (2006) Complicated acute type B dissections: An 8 years experience of endovascular stent-graft repair in a single center. Eur J Vasc Endovasc Surg 31:481–486PubMedCrossRefGoogle Scholar
  39. 39.
    Appoo JJ, Moser WG, Fairman RM, Cornelius KF, Pochettino A, Woo EY, Kurichi JE, Carpenter JP, Bavaria JE (2006) Thoracic aortic stent grafting: Improving results with newer generation investigational devices. J Thorac Cardiovasc Surg 131:1087–1094PubMedCrossRefGoogle Scholar
  40. 40.
    Greenberg RK, O´Neill S, Walker E, Haddad F, Lyden SP, Svensson LG, Lytle B, Clair DG, Ouriel K (2005) Endovascular repair of thoracic aortic lesions with the Zenith TX1 and TX2 thoracic grafts. Intermediate-term results. J Vasc Surg 41:589–596CrossRefGoogle Scholar
  41. 41.
    Farber MA, Criado FJ (2005) Endovascular repair of nontraumatic ruptures thoracic aortic pathologies. Ann Vasc Surg 19:167–171PubMedCrossRefGoogle Scholar
  42. 42.
    Eggebrecht H, Schmermund A, Herold U, Baumgart D, Martini S, Kuhnt O, Ling AY, Kuhne C, Kuhl H, Kienbaum P, Peters J, Jakob HG, Erbel R (2005) Endovascular stent-graft placement for acute and contained rupture of the descending thoracic aorta. Catheter Cardiovasc Interv 66:474–482PubMedCrossRefGoogle Scholar
  43. 43.
    Pitton MB (2006) Diagnosis and management of endoleaks after endovascular aneurysm repair: The role of MRI. Abdom Imaging 31:339–346PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • M. B. Pitton
    • 1
    Email author
  • S. Herber
    • 1
  • W. Schmiedt
    • 2
  • A. Neufang
    • 2
  • B. Dorweiler
    • 2
  • C. Düber
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital of Mainz, Johannes Gutenberg University of MainzMainzGermany
  2. 2.Department of Cardiovascular SurgeryUniversity Hospital of Mainz, Johannes Gutenberg University of MainzMainzGermany

Personalised recommendations