This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Thoracic stent grafts. BJS 2001; 88: 617-618.
Published: 6th December 2002
Authors: D. J. Gerrard, C. L. McGuinness, T. Sabharwal, J. F. Reidy, P. R. Taylor
Background
The Endovascular Aneurysm Repair trial of infrarenal aortic aneurysm repair requires 20 operations to be performed at each centre to eliminate learning curve errors. An analysis was undertaken of the authors' learning curve experience of commercially made thoracic stent grafts.
Method
Stent grafting was attempted in 26 patients. Aortic pathology included 13 atheromatous aneurysms, six dissections, one coarctation, three false aneurysms and three transections. Successful deployment was performed in 24 patients (92 per cent), but failed in two women due to small iliac arteries. Stent grafts used were Gore Excluder (16 patients), AneuRx (six), Vanguard (one) and Stenford (one). Four patients required two stents, two needed three stents, and 18 had a single stent.
Results
Thirteen elective procedures were uneventful. Two deaths occurred in 11 urgent procedures, from pulmonary embolism and aortic rupture of an unsuspected false aneurysm. The overall in‐hospital mortality rate was 8 per cent (two of 24 patients). One graft with a persistent endoleak was removed at open repair at 6 weeks. The subclavian artery origin was covered in three elderly patients, resulting in minor distal ischaemia. No spinal cord problems were seen. One patient died from pneumonia at 8 weeks, and another died from rupture at 28 months as a result of prolapse of the stent into the aneurysm sac.
Conclusion
Assessment of the diameter of the iliac arteries is important, especially in women, to ensure that they accommodate the size of the sheath. Patients with false aneurysms have a poor outcome, and treatment by stent grafting may not be durable. Covering the origin of the left subclavian artery can be undertaken in elderly patients with transient minor symptoms. The use of stent grafts in acute type B dissection should be the subject of a randomized trial. Continued surveillance is essential. © 2001 British Journal of Surgery Society Ltd
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