Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Stent-Grafts: A safe therapeutic option for patients with impending rupture of the chest aorta

01.09.2003


Surgical repair of such aneurysms and interposition of vascular protheses were until recently the only treatment option for complicated cases (diameter „d 5.5 cm; impending rupture; malperfusion syndrome; recurrent pain). Although great strides have been achieved by improving surgical techniques, postoperative complications (such as persistent paralysis of both legs, stroke, acute renal failure or pulmonary dysfunction) and 30-day mortality remain high. Especially elderly patients with accompanying illnesses (high blood pressure, chronic pulmonary disease or heart failure) are at high risk. Therefore, these comorbidities have a significant impact on postoperative outcome and further life expectancy.

Conversely, endovascular stent-graft implantation seems to be a promising, non-surgical and less traumatic therapeutic option and avoids surgical opening of the chest. Endovascular protheses are based on the concept of a metal grid covered with graft material (Dacron). The natural healing process begins after complete sealing of the proximal entry tear in dissection (see figure 2) and induces thrombus formation in the false lumen and reconstruction of the aortic wall.

In our institution stent-graft placement was performed in the cardiac catheterization laboratory with patients under general anesthesia and ventilation. In all patients, the femoral or distal iliac artery was surgically exposed and the stent-graft was inserted, advanced and deployed inside the aorta with the use of fluoroscopy and simultaneous ultrasound. Once stent apposition was achieved, the catheter delivery system was removed, and the incision was surgically closed.



Between October 1997 and September 2002 105 patients were subjected to endovascular treatment of dissecting aneurysms in the chest aorta. This analysis describes the experience with this endovascular strategy in the largest reported group of patients. Delivery success was achieved in all patients. Early 30-day mortality was 2.8% and overall-mortality in the entire follow-up period (mean follow-up 32.4 „b 15.5 months, range 1 day - 64 months). was 10.5% (11 patients). Six patients died from late rupture of the chest aorta; additional five deaths were non-vascular.

Persistent neurological complications (strokes) after stent-graft implantation were observed in 2.8% during the entire follow-up period and temporary neurological complications without any residues in 7.6%. Persistent paralysis of both legs was not observed. Within midterm follow-up 6.6% of patients required a second adjunctive stent-graft intervention to seal secondary endoleaks or to treat progressive pathology of the aorta. Elective open surgery was necessary in 5.7% due to progression of aortic diameters with persistent perfusion of the false lumen.

Although our retrospective midterm-analysis after endovascular stent-graft placement suggests a beneficial outcome and confirms procedural safety, the concept of non-surgical aortic reconstruction should be subjected to randomized trials in order to demonstrate improvement of long-term prognosis for patients with dissecting aneurysms of the chest aorta. At this time such a European multi-center trial is ongoing (INSTEAD-study).

Professor Dr. med. Christoph A. Nienaber / Dr. med. Tim C. Rehders
Division of Cardiology, University of Rostock, Rostock, Germany

IMPORTANT: This press release accompanies a poster or oral session given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology
True aneurysms and dissecting aneurysms (see figure 1) of the chest aorta both represent life-threatening situations since with increasing diameters they tend to rupture and lead to fatal bleeding.

Camilla Dormer | alfa
Further information:
http://www.escardio.org/vpo

More articles from Health and Medicine:

nachricht 'Living bandages': NUST MISIS scientists develop biocompatible anti-burn nanofibers
16.02.2018 | National University of Science and Technology MISIS

nachricht New process allows tailor-made malaria research
16.02.2018 | Eberhard Karls Universität Tübingen

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: In best circles: First integrated circuit from self-assembled polymer

For the first time, a team of researchers at the Max-Planck Institute (MPI) for Polymer Research in Mainz, Germany, has succeeded in making an integrated circuit (IC) from just a monolayer of a semiconducting polymer via a bottom-up, self-assembly approach.

In the self-assembly process, the semiconducting polymer arranges itself into an ordered monolayer in a transistor. The transistors are binary switches used...

Im Focus: Demonstration of a single molecule piezoelectric effect

Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale

Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...

Im Focus: Hybrid optics bring color imaging using ultrathin metalenses into focus

For photographers and scientists, lenses are lifesavers. They reflect and refract light, making possible the imaging systems that drive discovery through the microscope and preserve history through cameras.

But today's glass-based lenses are bulky and resist miniaturization. Next-generation technologies, such as ultrathin cameras or tiny microscopes, require...

Im Focus: Stem cell divisions in the adult brain seen for the first time

Scientists from the University of Zurich have succeeded for the first time in tracking individual stem cells and their neuronal progeny over months within the intact adult brain. This study sheds light on how new neurons are produced throughout life.

The generation of new nerve cells was once thought to taper off at the end of embryonic development. However, recent research has shown that the adult brain...

Im Focus: Interference as a new method for cooling quantum devices

Theoretical physicists propose to use negative interference to control heat flow in quantum devices. Study published in Physical Review Letters

Quantum computer parts are sensitive and need to be cooled to very low temperatures. Their tiny size makes them particularly susceptible to a temperature...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

2nd International Conference on High Temperature Shape Memory Alloys (HTSMAs)

15.02.2018 | Event News

Aachen DC Grid Summit 2018

13.02.2018 | Event News

How Global Climate Policy Can Learn from the Energy Transition

12.02.2018 | Event News

 
Latest News

Japanese researchers develop ultrathin, highly elastic skin display

19.02.2018 | Information Technology

Dispersal of Fish Eggs by Water Birds – Just a Myth?

19.02.2018 | Ecology, The Environment and Conservation

Studying mitosis' structure to understand the inside of cancer cells

19.02.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>