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 Chronic stress induces fatal organ dysfunctions via a new neural circuit
21.08.2017 | Hokkaido University

nachricht New malaria analysis method reveals disease severity in minutes
14.08.2017 | University of British Columbia

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: Fizzy soda water could be key to clean manufacture of flat wonder material: Graphene

Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.

As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...

Im Focus: Exotic quantum states made from light: Physicists create optical “wells” for a super-photon

Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.

Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...

Im Focus: Circular RNA linked to brain function

For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.

While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...

Im Focus: RAVAN CubeSat measures Earth's outgoing energy

An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.

The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...

Im Focus: Scientists shine new light on the “other high temperature superconductor”

A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.

Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Call for Papers – ICNFT 2018, 5th International Conference on New Forming Technology

16.08.2017 | Event News

Sustainability is the business model of tomorrow

04.08.2017 | Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

 
Latest News

Nagoya physicists resolve long-standing mystery of structure-less transition

21.08.2017 | Materials Sciences

Chronic stress induces fatal organ dysfunctions via a new neural circuit

21.08.2017 | Health and Medicine

Scientists from the MSU studied new liquid-crystalline photochrom

21.08.2017 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>