Skip to main content
Log in

Mid-Term Results of Endovascular Treatment for Descending Thoracic Aorta Diseases in High-Surgical Risk Patients

  • Papers Presented to the French Vascular Surgery Society
  • Published:
Annals of Vascular Surgery


We report the initial experience of two cardiovascular surgery centers in the treatment of descending thoracic aorta lesions with covered stent grafts in high-surgical risk patients. From April 1999 to November 2004, 54 patients, mean age 64 years (range 16-83), were treated by stent graft for a lesion of the descending aorta (degenerative aneurysms n = 22, aortic dissections n = 12, chronic post traumatic aneurysms n = 5, anastomotic false aneurysms n = 2, penetrating ulcers n = 4, intramural hematomas n = 5, traumatic rupture n = 4), with 42.6% treated on an emergency basis. Three devices were used: Talent® (n = 49), Excluder® (n = 4), and Zenith® (n = 1). In three patients, combined surgery of the proximal aorta was performed. Prior bypass of the left supra-aortic arteries was performed in four patients. The follow-up was clinical and radiological (plain chest film and computed tomographic scan) at 1, 3, 6, 12, 18, and 24 months and yearly thereafter. The stent graft was successfully deployed in all cases. Two early deaths related to the stent graft (one migration and aortic rupture and one stroke) and one related to adult respiratory distress syndrome occurred. Morbidity was 16.6% (iliac access damage n = 4, groin reintervention n = 3, transient ischemic attack n = 1, tamponade n = 1). The follow-up was 100% complete (mean 22.8 months, range 3-51). Fifteen primary endoleaks (type I n = 6, type II n = 8, type III n = 1) and one secondary endoleak were reported. They were treated by additional stent graft (n = 7) and elective surgical conversion (n = 1). Six endoleaks resolved spontaneously at 6 months, and two are being monitored. Twelve endoleaks (75%) occurred in patients treated for degenerative aneurysms. Freedom from secondary reintervention was 81.3% at 3 years. Two transient paraparesias were observed at 3 and 18 months. Of the 13 deaths observed during the follow-up, only one was related to the stent graft. Actuarial survival at 12 and 24 months was 90.0% and 75.4%, respectively. Mortality results are encouraging in this specific cohort of high-surgical risk patients. A new kind of morbidity is observed, related to endoleaks, whose necessary management could hinder the durability of the technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

Similar content being viewed by others


  1. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent graft placement for the treatment of acute aortic dissection. N Engl J Med 1999;340:1546-1552

    Article  PubMed  CAS  Google Scholar 

  2. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent graft placement. N Engl J Med 1999;340:1539-1545

    Article  PubMed  CAS  Google Scholar 

  3. Demers P, Miller DC, Mitchell RS, et al. Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts. J Thorac Cardiovasc Surg 2004;127:664-673

    Article  PubMed  Google Scholar 

  4. White GH, Yu W, May J, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 1997;4:152-168

    Article  PubMed  CAS  Google Scholar 

  5. Fattori R, Napoli G, Lovato L, et al. Descending thoracic aortic diseases: stent graft repair. Radiology 2003;229:176-183

    PubMed  Google Scholar 

  6. Bortone AS, Schena S, D’Agostino D, et al. Immediate versus delayed endovascular treatment of post-traumatic aortic pseudoaneurysms and type B dissections: retrospective analysis and premises to the upcoming European trial. Circulation 2002;106:I234-I240

    PubMed  Google Scholar 

  7. Ellozy SH, Carroccio A, Minor M, et al. Challenges of endovascular tube graft repair of thoracic aortic aneurysm: midterm follow-up and lessons learned. J Vasc Surg 2003;38:676-683

    Article  PubMed  Google Scholar 

  8. Temudom T, D’Ayala M, Marin ML, et al. Endovascular grafts in the treatment of thoracic aortic aneurysms and pseudoaneurysms. Ann Vasc Surg 2000;14:230-238

    Article  PubMed  CAS  Google Scholar 

  9. Greenberg RK, O’Neill S, Walker E, et al. Endovascular repair of thoracic aortic lesions with the Zenith TX1 and TX2 thoracic grafts: intermediate-term results. J Vasc Surg 2005;41:589-596

    Article  PubMed  Google Scholar 

  10. Rehders TC, Petzsch M, Ince H, et al. Intentional occlusion of the left subclavian artery during stent graft implantation in the thoracic aorta: risk and relevance. J Endovasc Ther 2004;11:659-666

    Article  PubMed  Google Scholar 

  11. Roseborough G, Burke J, Sperry J, et al. Twenty-year experience with acute distal thoracic aortic dissections. J Vasc Surg 2004;40:235-246

    Article  PubMed  Google Scholar 

  12. Nevelsteen A, Endovascular treatment for thoracic aortic dissection: the better solution? Eur Heart J 2006;27:384–385

    Article  PubMed  Google Scholar 

  13. Verhoye J-Ph De Latour B, Heautot JF. Return of renal function after endovascular treatment of aortic dissection. N Engl J Med 2005;17:1824-1825

    Article  Google Scholar 

  14. Roques X, Remes J, Laborde MN, et al. Surgery of chronic traumatic aneurysm of the aortic isthmus: benefit of direct suture. Eur J Cardiothorac Surg 2003;23:46-49

    Article  PubMed  CAS  Google Scholar 

  15. Demers P, Miller C, Scott Mitchell R, et al. Chronic traumatic aneurysms of the descending thoracic aorta: mid-term results of endovascular repair using first and second-generation stent grafts. Eur J Cardiothorac Surg 2004;25:394-400

    Article  PubMed  Google Scholar 

  16. Evangelista A, Mukherjee D, Mehta RH, et al. International Registry of Aortic Dissection (IRAD) investigators. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 2005;111:1063-1070

    Article  PubMed  Google Scholar 

  17. Demers P, Miller DC, Mitchell RS, et al. Stent graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: mid-term results. Ann Thorac Surg 2004;77:81-86

    Article  PubMed  Google Scholar 

  18. Rousseau H, Dambrin C, Marcheix B, et al. Acute traumatic aortic rupture: a comparison of surgical and stent graft repair. J Thorac Cardiovasc Surg 2005;129:1050-1055

    Article  PubMed  CAS  Google Scholar 

  19. Rousseau H, Soula P, Perreault P, et al. Delayed treatment of traumatic rupture of the thoracic aorta with endoluminal covered stent. Circulation 1999;99:498-504

    PubMed  CAS  Google Scholar 

  20. Beregi JP, Prat A, Gaxotte V, et al. Endovascular treatment for dissection of the descending aorta. Lancet 2000;356:482-483

    Article  PubMed  CAS  Google Scholar 

  21. Kusagawa H, Shimono T, Ishida M, et al. Changes in false lumen after transluminal stent graft placement in aortic dissections: six years’ experience. Circulation 2005;111:2951-2957

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jean-Philippe Verhoye MD.

About this article

Cite this article

Verhoye, JP., de Latour, B., Heautot, JF. et al. Mid-Term Results of Endovascular Treatment for Descending Thoracic Aorta Diseases in High-Surgical Risk Patients. Ann Vasc Surg 20, 714–722 (2006).

Download citation

  • Published:

  • Issue Date:

  • DOI: