Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts**Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc.

Lars G. Svensson, Nicholas T. Kouchoukos, D. Craig Miller, Joseph E. Bavaria, Joseph S. Coselli, Michael Curi, Holger Eggebrecht, John A. Elefteriades, Raimund Erbel, Thomas G. Gleason, Bruce W. Lytle, R. Scott Mitchell, Christoph A. Nienaber, Eric E. Roselli, Hazim J. Safi, Richard J. Shemin, Gregorio A. Sicard, Thoralf M. Sundt, Wilson Y. Szeto, Grayson H. Wheatley

Research output: Contribution to journalArticle

629 Citations (Scopus)

Abstract

Between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and continues to increase. For the thoracic aorta, these diseases are increasingly treated by stent-grafting. No prospective randomized study exists comparing stent-grafting and open surgical treatment, including for disease subgroups. Currently, one stent-graft device is approved by the Food and Drug Administration for descending thoracic aortic aneurysms although two new devices are expected to obtain FDA approval in 2008. Stent-graft devices are used "off label" or under physician Investigational Device Exemption studies for other indications such as traumatic rupture of the aorta and aortic dissection. Early first-generation devices suffered from problems such as stroke with insertion, ascending aortic dissection or aortic penetration from struts, vascular injury, graft collapse, endovascular leaks, graft material failure, continued aneurysm expansion or rupture, and migration or kinking; however, the newer iterations coming to market have been considerably improved. Although the devices have been tested in pulse duplicators out to 10 years, long-term durability is not known, particularly in young patients. The long-term consequences of repeated computed tomography scans for checking device integrity and positioning on the risk of irradiation-induced cancer remains of concern in young patients. This document (1) reviews the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts; and (2) offers suggestions for treatment.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
Volume85
Issue number1 SUPPL.
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

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Thoracic Diseases
Training Support
Aortic Diseases
Stents
Transplants
Equipment and Supplies
Therapeutics
Aorta
Dissection
Thoracic Aortic Aneurysm
Aortic Rupture
Vascular System Injuries
Abdominal Aortic Aneurysm
United States Food and Drug Administration
Thoracic Aorta
Aneurysm
Rupture
Stroke
Tomography
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Svensson, Lars G. ; Kouchoukos, Nicholas T. ; Miller, D. Craig ; Bavaria, Joseph E. ; Coselli, Joseph S. ; Curi, Michael ; Eggebrecht, Holger ; Elefteriades, John A. ; Erbel, Raimund ; Gleason, Thomas G. ; Lytle, Bruce W. ; Mitchell, R. Scott ; Nienaber, Christoph A. ; Roselli, Eric E. ; Safi, Hazim J. ; Shemin, Richard J. ; Sicard, Gregorio A. ; Sundt, Thoralf M. ; Szeto, Wilson Y. ; Wheatley, Grayson H. / Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts**Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 1 SUPPL.
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abstract = "Between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and continues to increase. For the thoracic aorta, these diseases are increasingly treated by stent-grafting. No prospective randomized study exists comparing stent-grafting and open surgical treatment, including for disease subgroups. Currently, one stent-graft device is approved by the Food and Drug Administration for descending thoracic aortic aneurysms although two new devices are expected to obtain FDA approval in 2008. Stent-graft devices are used {"}off label{"} or under physician Investigational Device Exemption studies for other indications such as traumatic rupture of the aorta and aortic dissection. Early first-generation devices suffered from problems such as stroke with insertion, ascending aortic dissection or aortic penetration from struts, vascular injury, graft collapse, endovascular leaks, graft material failure, continued aneurysm expansion or rupture, and migration or kinking; however, the newer iterations coming to market have been considerably improved. Although the devices have been tested in pulse duplicators out to 10 years, long-term durability is not known, particularly in young patients. The long-term consequences of repeated computed tomography scans for checking device integrity and positioning on the risk of irradiation-induced cancer remains of concern in young patients. This document (1) reviews the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts; and (2) offers suggestions for treatment.",
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Svensson, LG, Kouchoukos, NT, Miller, DC, Bavaria, JE, Coselli, JS, Curi, M, Eggebrecht, H, Elefteriades, JA, Erbel, R, Gleason, TG, Lytle, BW, Mitchell, RS, Nienaber, CA, Roselli, EE, Safi, HJ, Shemin, RJ, Sicard, GA, Sundt, TM, Szeto, WY & Wheatley, GH 2008, 'Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts**Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc.', Annals of Thoracic Surgery, vol. 85, no. 1 SUPPL.. https://doi.org/10.1016/j.athoracsur.2007.10.099

Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts**Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc. / Svensson, Lars G.; Kouchoukos, Nicholas T.; Miller, D. Craig; Bavaria, Joseph E.; Coselli, Joseph S.; Curi, Michael; Eggebrecht, Holger; Elefteriades, John A.; Erbel, Raimund; Gleason, Thomas G.; Lytle, Bruce W.; Mitchell, R. Scott; Nienaber, Christoph A.; Roselli, Eric E.; Safi, Hazim J.; Shemin, Richard J.; Sicard, Gregorio A.; Sundt, Thoralf M.; Szeto, Wilson Y.; Wheatley, Grayson H.

In: Annals of Thoracic Surgery, Vol. 85, No. 1 SUPPL., 01.01.2008.

Research output: Contribution to journalArticle

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T1 - Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts**Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc.

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AU - Elefteriades, John A.

AU - Erbel, Raimund

AU - Gleason, Thomas G.

AU - Lytle, Bruce W.

AU - Mitchell, R. Scott

AU - Nienaber, Christoph A.

AU - Roselli, Eric E.

AU - Safi, Hazim J.

AU - Shemin, Richard J.

AU - Sicard, Gregorio A.

AU - Sundt, Thoralf M.

AU - Szeto, Wilson Y.

AU - Wheatley, Grayson H.

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