Endovascular Grafting for Various Conditions of the Descending Thoracic Aorta

Since 1995 a total of 129 patients with aneurysm, dissection, or other conditions of the descending thoracic aorta were treated by a homemade stent-graft system. The basic framework of our system consisted of Gianturco Z stents connected at each section by two longitudinal struts and covered with a thin-walled woven polyester fabric. Under fluoroscopy, the stent-graft was deployed in the aorta through a sheath introduced by the brachial-femoral traction guidewire technique called “tug of wire.” The flexible stent device enabled successful stent-graft deployment, particularly in the proximal descending aorta. A predeployment test using a novel retrievable stent-graft helps predict the possibility of spinal cord ischemia in patients with the target region located in the critical distal descending aorta. The fate of the dissected false lumen treated by endovascular primary entry closure depends not only on size and the location of reentry but on the period after onset. Balloon fenestration efficiently prevented visceral malperfusion following entry closure. Although anastomotic pseudoaneurysms can be successfully repaired, hemoptysis does not disappear if the lung was damaged by aneurysm formation. Traumatic and inflammatory aneurysms are good candidates for endovascular grafting, although long-term follow-up results must be investigated.