Descending thoracic aortic aneurysm repair using a modified Z-stent prosthesis

The purpose of this article is to review the technique and 5-year experience of endovascular stent-grafting of the thoracic aorta. From 1992 through 1997, 118 patients (83 male, 35 female) underwent stent-graft treatment for descending thoracic aortic aneurysms. The stent-grafts were constructed from Z-stents and covered with woven polyester. The devices were deployed using a 20F to 24F sheath introduced through a femoral arteriotomy or retroperitoneal exposure of the distal abdominal aorta. The average aneurysm diameter was 6.2 cm (range: 4-11 cm) and mean stent-graft dimension was 3.4 cm (range: 2.4-4.5 cm) in diameter and 10.6 cm (range: 4.0-22 cm) in length. Stent-graft deployment was technically successful in 99% (n = 117). Ten patients died in the perioperative period (8.4%). Paraplegia occurred in four patients (3.4%) but there were no complications of distal embolization or stent-graft infection. Overall rate of aneurysm thrombosis was 96% (n = 113) after endovascular stent-graft placement. This preliminary experience shows that stent-grafting in the thoracic aorta is technically feasible and can be used safely to treat highly selected cases of descending thoracic aortic aneurysms. Long-term follow-up is necessary to assess its efficacy in preventing subsequent aneurysm rupture.