The evaluation of the aortic stent grafts open with proksimally controlled that are used in the patients with toracic aort pathologies: Short-term and mid-term results

PURPOSE:In this study we retrospectively evaluated and short-term and mid-term results of the aortic stent grafts open with proksimally controlled that are currently being used in our clinic among the patients with toracic aort pathologies.MATERİALS AND METHODS:Between December 2009 and June 2011, we evaluated preoperative demographic, operative, perioperative (<1 month), short-term (1-3months) and mid-term (>3months) datas of 28 patients who underwent the aortic stent grafts open with proksimally controlled therapy due to thoracic aort pathology . These datas had been evaluated between dissection-aneurysm groups and stent greft group 1 (Valiant Captivia) and stent greft group 2(Jotec Evita) additionally and statistical analysis were made.RESULTS:Among the 28 patients included into the study, 9 (%32,1) had thoracic aortic aneurysm, 5 (%17,8) had thoracicoabdominal aortic aneurysm, 7 (%25) had acute type B dissection, 5 (%17,8) had chronic type B dissection, 1 (%3,5) had penetrative aortic ulcer and 1 (%3,5) had pseudoaneurysm. Based on these endications the patients had endovascular stent greft therapy. Mean age values were found as 64 (±8,4), 56,5(±12,9), in aneurysm and dissection groups respectively . The mean age of all the patients were 60,79(±11). When evaluated the first one month after the operation,technical success and lession exclusion rate was %100 in the aneurysm, dissection and all groups. There was not any mortality in the aneurysm group during the first 30 days, although in dissection group 1 patient (%8,3), totally 1 patient(%3,6) was lost in the first 30 days. A major complication had been seen only in 1 patient (%8,3) in dissection group , totally 1 patient(%3,6), while non had been seen in the aneurysm group. During the perioperative period , no endoleak complication had been seen and no patient had a secondary procedure. During early period(1-3 months)lesion related mortality was not seen in any group, although, mortality not related to any lesion, was seen only in 1 patient(%6,3). In aneurysm group, 3 patients (%18,7), in dissection group 2 patients( %18,1) totally 5 patients(%18,5) had a secondary procedure. In 3 patient (%18,7) of the aneurysm group, in 1 patient (%9,0) of the dissection group and totally in 4 patients (%14,8), endoleak was observed. During the early period, none of the patients had an arterial rupture nor any systemic complication. In stent graft group 2, only 1 patient(%11,1) had a complication related to device , while it was not seen in any patient in stent graft group 1. When aneurysm-dissection group and stent graft group 1-stent graft group 2 compared to each other, short -term results did not show any statistical difference(p>0,05).In this study the medium follow-up time of the patients was measured as 7,89(±6,3) months. During the mid-term follow-up period, none of the groups had developed mortality, arterial rupture, arterial dissection, complication related to device or systemic complication. A secondary procedure was applied to 1 patient in the aneurysm group(%12,5) and in total (%6,3), although it was not necessary for any patient in the dissection group. There was no endoleak observed in the dissection group. Endoleak was observed in 3 patients (%%37,5) of the aneurysm group and %18,7 of the total number of the patients. In the mid-term, when compared aneurysm and dissection groups with stent greft group 1 and stent greft group 2, we did not find any statistical difference in the results.CONCLUSION:Thoracic stent grefts were examined under different groups in many studies in the medical literature. Other than the literature, short-term and mid-term effectivity of the stent grafts open with proksimally controlled, was studied. According to our study,the technical success, lession exclusion , perioperative mortalite, endoleak rates and short-term, mid-term lession relatied mortality , major complication rates were found beter than the literatüre in all the groups which were used Valiant Captivia ve Jotec Evita stent grafts. We think that, stent grafts open with proksimally controlled with their operational comfort, increased the general success during the perioperative time and showed a clear advance than the other stent grafts with their lesser mortality and major complication rates. On the other hand, short-term and mid-term endoleak and secondary procedure rates have been found to be high compared to the literature. That is why we believe stent grafts open with proksimally controlled can be evaluated more properly by studies with larger patient populations and longer follow-up times.