lCLINICAL INVESTIGATION l Treatment of Thoracic Aortic Dissection With Stent-Grafts: Midterm Results

l l Purpose: To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta. Methods: Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 6 13.7 years, range 32–82) with descending thoracic aortic dis-section. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up. Results: Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the pro-cedure. Over an average follow-up of 31.5 6 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 pa-tients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved. Conclusions: Endovascular stent-graft implantation in descending thoracic aortic dissec-tion is a feasible, safe, and effective treatment modality. However, further studies are nec-essary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified