Endoluminal stent grafting of the descending thoracic aorta

Background: The timing and optimal therapy for descending thoracic aortic diseases still remain a challenging problem for surgeons. Nowadays endovascular treatment is becoming more and more popular both for acute as well as chronic cases. This technique is more respectful of the tissue integrity and avoids major and demolitive surgery for the patient. Methods: In 1 year 32 patients presenting with descending thoracic aorta dissection (n = 25) or with descending thoracic aorta aneurysms (n = 7) were submitted to an endovascular procedure using covered stents. Ten of them were operated upon in general anesthesia whereas in 22 spinal anesthesia was administered. In neither group did anesthesia-related complications occur. Results: In all cases in which endovascular treatment was possible, an endovascular stent was used for the treatment of the descending thoracic aorta disease. Only 1 patient had a major complication, which was a retrograde dissection of the ascending aorta surgically treated in an emergency setting. Our policy is to treat uncomplicated type B dissections in the subacute phase after 1 week of antihypertensive pharmacological treatment, but within 1 month of onset. Our mid-term follow-up shows very good results with no mortality and no stent-related complications. Conclusions: Stent grafting is replacing conventional surgery for descending thoracic aorta aneurysms and dissections. Our results suggest that in case of dissections, endovascular treatment should be delayed until the subacute phase, in the absence of complications. The risks and mortality are decreased.