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 The genes are not to blame
20.07.2018 | Technische Universität München

nachricht Targeting headaches and tumors with nano-submarines
20.07.2018 | Universitätsmedizin der Johannes Gutenberg-Universität Mainz

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: Future electronic components to be printed like newspapers

A new manufacturing technique uses a process similar to newspaper printing to form smoother and more flexible metals for making ultrafast electronic devices.

The low-cost process, developed by Purdue University researchers, combines tools already used in industry for manufacturing metals on a large scale, but uses...

Im Focus: First evidence on the source of extragalactic particles

For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.

To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...

Im Focus: Magnetic vortices: Two independent magnetic skyrmion phases discovered in a single material

For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.

Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...

Im Focus: Breaking the bond: To take part or not?

Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.

A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...

Im Focus: New 2D Spectroscopy Methods

Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.

"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Leading experts in Diabetes, Metabolism and Biomedical Engineering discuss Precision Medicine

13.07.2018 | Event News

Conference on Laser Polishing – LaP: Fine Tuning for Surfaces

12.07.2018 | Event News

11th European Wood-based Panel Symposium 2018: Meeting point for the wood-based materials industry

03.07.2018 | Event News

 
Latest News

A smart safe rechargeable zinc ion battery based on sol-gel transition electrolytes

20.07.2018 | Power and Electrical Engineering

Reversing cause and effect is no trouble for quantum computers

20.07.2018 | Information Technology

Princeton-UPenn research team finds physics treasure hidden in a wallpaper pattern

20.07.2018 | Materials Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>