Acute and contained rupture of the descending thoracic aorta: Treatment with endovascular stent grafts

AbstractPurpose: The purpose of this study was to evaluate feasibility and safety of endovascular stent grafting for the treatment of patients with rupture of the descending thoracic aorta. Methods: Thirteen patients with rupture of the descending thoracic aorta were treated with endovascular stent grafting. Six patients were treated on the day of diagnosis because their vital signs were unstable, and the other seven patients were treated electively. Five patients had infection or potential infection, and the other eight patients did not. Expanded polytetrafluoroethylene-covered or polyester-covered Z stents were used in all patients. Results: Stent grafts were successfully placed in all patients. No endoleaks were observed at the end of the procedure. However, rebleeding was observed within 2 weeks of the procedure in two patients with infection. Six patients (46%) died within 5 months of the procedure (mean survival period, 61 ± 60 days). All five patients with infection (100%) died, and only one of eight patients without infection (13%) died (P <.01). The remaining seven patients are alive during the mean follow-up period of 21 months (overall survival rate, 54%), although additional surgical interventions, including surgical conversion in one case and upper extremity extraanatomic bypass in the other, were necessary in two of these patients. Conclusion: Endovascular stent grafting may be a safe and feasible method for the treatment of rupture of the descending thoracic aorta in selected patients without infection. However, its usefulness in terms of long-term prognosis appears to be extremely limited, especially in patients with infection. (J Vasc Surg 2003;37:100-5.