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 Researchers identify new way to unmask melanoma cells to the immune system
17.01.2018 | Duke University Medical Center

nachricht Study advances gene therapy for glaucoma
17.01.2018 | University of Wisconsin-Madison

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: Scientists decipher key principle behind reaction of metalloenzymes

So-called pre-distorted states accelerate photochemical reactions too

What enables electrons to be transferred swiftly, for example during photosynthesis? An interdisciplinary team of researchers has worked out the details of how...

Im Focus: The first precise measurement of a single molecule's effective charge

For the first time, scientists have precisely measured the effective electrical charge of a single molecule in solution. This fundamental insight of an SNSF Professor could also pave the way for future medical diagnostics.

Electrical charge is one of the key properties that allows molecules to interact. Life itself depends on this phenomenon: many biological processes involve...

Im Focus: Paradigm shift in Paris: Encouraging an holistic view of laser machining

At the JEC World Composite Show in Paris in March 2018, the Fraunhofer Institute for Laser Technology ILT will be focusing on the latest trends and innovations in laser machining of composites. Among other things, researchers at the booth shared with the Aachen Center for Integrative Lightweight Production (AZL) will demonstrate how lasers can be used for joining, structuring, cutting and drilling composite materials.

No other industry has attracted as much public attention to composite materials as the automotive industry, which along with the aerospace industry is a driver...

Im Focus: Room-temperature multiferroic thin films and their properties

Scientists at Tokyo Institute of Technology (Tokyo Tech) and Tohoku University have developed high-quality GFO epitaxial films and systematically investigated their ferroelectric and ferromagnetic properties. They also demonstrated the room-temperature magnetocapacitance effects of these GFO thin films.

Multiferroic materials show magnetically driven ferroelectricity. They are attracting increasing attention because of their fascinating properties such as...

Im Focus: A thermometer for the oceans

Measurement of noble gases in Antarctic ice cores

The oceans are the largest global heat reservoir. As a result of man-made global warming, the temperature in the global climate system increases; around 90% of...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

10th International Symposium: “Advanced Battery Power – Kraftwerk Batterie” Münster, 10-11 April 2018

08.01.2018 | Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

 
Latest News

Polymers Based on Boron?

18.01.2018 | Life Sciences

Bioengineered soft microfibers improve T-cell production

18.01.2018 | Life Sciences

World’s oldest known oxygen oasis discovered

18.01.2018 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>