Two-Year Single-Center Experience with Thoracic Endovascular Aortic Repair Using the EndoFit Thoracic Stent-Graft

Abstract

Purpose:

To analyze our single-center experience of thoracic endovascular aortic aneurysm repair (TEVAR) using the EndoFit Thoracic Aortic Endograft.

Methods:

A retrospective review was conducted of 87 consecutive patients (64 men; median age 67.8±8.7 years, range 24–88) undergoing TEVAR using the EndoFit thoracic stent-graft from December 2005 to December 2007. Slightly more than half (n=46) of the patients had thoracic aortic aneurysm, while 41 had thoracic aortic dissection. Seventeen cases were performed emergently. All patients had imaging follow-up before discharge; at 1, 3, and 6 months; and annually thereafter.

Results:

The technical success rate was 100%. Fifty-five (63.2%) patients had different debranching procedures to extend the proximal or distal landing zone. The in-hospital and 30-day mortality rate was 9.2% (8/87). Neurological complications occurred in 8 (9.3%) patients, including 5 strokes (2 fatal) and 3 cases of paraplegia. One intraoperative massive bleeding from an ascending aortic debranching anastomosis was rescued with the aid of a pump. Five patients had immediate proximal type I endoleak; 3 were remedied with a proximal cuff, 1 was rescued with tri-lobe balloon, and 1 was left untreated. One type II endoleak remains under observation. The average follow-up was 15.2 months (range 5–29), during which 10 (11.5%) patients died of causes unrelated to the aneurysm or stent-graft. All the extra-anatomical bypasses and stent-grafts were patent; no stent-graft kinking, collapse, or dislocation was detected. Two post-TEVAR proximal endoleaks were remedied with a proximal cuff after debranching. There was no post-TEVAR rupture or conversion to open surgery.

Conclusion:

Our 2-year single-center experience using the EndoFit system for TEVAR showed a high technical success rate and a low incidence of device- or aneurysm-related complications. The flexible, hydrophilic introducer was easy to insert and track through the vasculature. The debranching techniques to extend the landing zones not only broaden the applicability of TEVAR but also reduce post-TEVAR complications.

Keywords

thoracic aortic aneurysm thoracic aortic dissection endovascular repair/therapy stent-graft debranching technique extra-anatomical bypass

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