జర్నల్ ఆఫ్ వాస్కులైటిస్

Treatment of Complex Aorta Diseases by Multilayer Stents

Abstract

Mohamed Nadjib Bouayed, Leila Bouziane, Abderrahmane Sekkal and Sid Ahmed Benaroussi

Purpose: The aim of our study was to evaluate the role of multilayer stents (MLS) in the therapeutic arsenal of complex aortic pathologies for frail patients combining several comorbidities that are initially objected to the conventional surgical treatment.
Materials and methods: Since March 2012, we conducted a monocentric prospective study on a series of 41 procedures, performed on 41 aortic lesion locations in 38 patients treated with multilayer stents. The series was divided into four groups. The first group included 21 cases: 20 thoracoabdominal aneurysms and one aneurysm of the entire descending thoracic aorta. The second group included 7 cases of juxta/infra renal aneurysms, the third group included 5 cases of false aneurysms and the fourth group included 8 cases of aortic dissecting hematoma (first subgroup: 6 cases) or extended dissections (second subgroupe: 2 cases).Three patients were treated during the same operation for a double aneurysm location (thoracic and abdominal in 2 cases and aortic arch and thoracic aorta in the 3rd case).
Results: The series included 25 men and 13 women with an average age of 63 years (40-84 years). The procedures were performed under local anesthesia in 3 cases, loco regional in 19 cases and general anesthesia in 16 cases. The average hospital stay was 7 days (4-14 days).The technical placement of the MLS was successful for the 41 procedures. No paraplegia, no stroke and no mesenteric ischemia occurred. Three complications related to the surgical approach were treated surgically with success. Two patients had post-operative renal failure for which one required dialysis. The 30-day mortality in relation to the aneurysm was 3% (one case of rupture in the first postoperative day) and unrelated to the aneurysm 3% (one case of massive myocardial infarction after the procedure). For an average follow up of 12 months (1-20 months) mortality unrelated to the aneurysm was 25% (9 deaths) and 0% in relation to the aneurysm. Among the 38 remaining aortic lesions treated and followed, the aneurismal sac was not feeded in 14 cases (63%) with 6 out of 20 cases in group 1(30%), 3 out of 6 cases in group 2(50%), 3 out of 4 cases in group 3 (75%) and finally 2 out of 6 cases in the first subgroup of group 4 (33%). The aneurismal sac is not feeded in 19 cases (50 %), including 14 out of 20 cases in group 1 (70%), 2 out of 6 cases in group 2 (33%), 1 out of 4 cases in the group 3(25%) and 2 out of 6 cases in the first subgroup of group 4 (33%). Two cases of extensive dissections treated remained stable without aneurismal changes. Three cases are recent: 1 out of 6 cases in group 2 (17%) and 2 out of 6 (33%) in the first subgroup of group 4 (33%). Visceral arteries and supraaortic trunks remained patent in all the 38 cases.
Conclusion: MLS may be an option treatment for dissections and complex aortic aneurysms in frail patients with high surgical risk. Our results showed that better results are obtained for false aneurysms and true aortic aneurysms without involvement of significant side branches.