Results after endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta.

Background: The purpose of this study was to determine durability and need for reinterventions after endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta.

Methods: We performed a prospective follow-up analysis of a consecutive series of 79 patients undergoing endovascular stent graft placement due to atherosclerotic aneurysms involving the descending aorta between 1996 and 2006. Acute aortic syndromes were excluded from this analysis. Mean follow-up was 42 months (range, 1 to 108 months). Data were collected for in-hospital mortality, occurrence of early and late endoleaks, reintervention due to early and late endoleaks, and survival.

Results: In-hospital mortality was 6.3% (n = 5). Two of these patients underwent emergent treatment. Early type I and III endoleaks were observed in 29% of patients (n = 23). The assisted primary endoleak rate was 11%. Late type I or III endoleaks occurred in 21% (n = 17). At 1, 3, and 5 years, overall actuarial survival was 96%, 86%, and 69%, and event-free survival was 90%, 82%, and 65%, respectively. Cox proportional hazard analysis revealed that a short proximal landing zone and a high number of stent grafts used were independent risk factors for early and late endoleak formation. Late endoleak formation was an independent predictor of survival.

Conclusions: Endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta has satisfactory durability. An extensive landing zone is a prerequisite of early and late success. Further clinical investigations are warranted to evaluate long-term durability of this attractive treatment modality.