Our experience of multilayer stent in treatment of complex aortic pathologies

Abstract

Purpose: The aim of our study was to evaluate the role
of multilayer stents in the therapeutic arsenal of complex
aortic pathologies in fragile patients combining several
risk factors that are initially objected to the conventional
surgical treatment
Materials and methods: From March 2012, we
conducted a prospective study, mono-centric to a series of
41 procedures performed on 41 lesion locations on
38 patients treated by multilayer stents (MLS). The series
is divided into four groups. The first group includes
21 cases: 20 thoracoabdominal aneurysms classified
Crawford type I: 2 cases, type II: 4 cases Type III: 4 cases,
type IV : 10 cases and one aneurysm of the entire
descending thoracic aorta. The average diameter of these
aneurysms was 71mm (54 - 98mm).
The second group consists of case 7 in juxta and under
renal aneurysms and the average diameter of 73mm is [62
- 97mm]. The third group comprises 5 cases of false
aneurysms. The fourth group includes 8 cases of aortic
dissection hematoma or extended dissections 3 patients
were treated in the same operation for a double aneurysm
location (thoracic and abdominal in 2 cases and aortic
arch and thoracic aorta in the 3rd case).
The series includes 25 men and 13 women with an
average age of 63 ans (40 - 84 years). The procedures were
performed under local anesthesia in 3 cases (7.89 %), loco
regional in 19 cases (50%) and in general 16 cases
(42.11%). The average hospital stay was 7 days (4 -
14 days).
Results: The initial technical success was 100%. There
was no paraplegia, no stroke and no mesenteric ischemia.
Three complications related to the surgical approach
were treated surgically with success. Two patients had
post operative renal failure, one of them was dialyzed
(2.63%).
The 30-day mortality associated with aneurysm was
2.63% (1 case of rupture in the first postoperative day)
and unrelated to the aneurysm 2.63% (a case of massive
myocardial infarction after the procedure). A mean follow
up of 12 months (1 to 20 months) mortality unrelated to
the aneurysm was 23.68% ( 9 deaths ) and in relation to
the aneurysm 0%. Of the 38 locations lesion treated and
followed, the aneurismal sac was not supplied in 14 cases
(63.15% ) with 6/20 cases (30% ) in group 1, 3/6 cases
(50%) in group 2, 3/4 cases (75 %) in group 3 and finally
2/6 cases ( 33.33 %) in the first sub group of group 4. The
aneurismal sac is poorly supplied in 19 cases (50 %),
including 14/20 cases (70 %) in group 1, 2/ 6 cases
(33.33%) in group 2 , 1/4 cases (25 %) in the group 3 and
2/ 6 cases (33.33%) in the first sub group of group 4.
2 cases of extensive dissections treated remained stable
without aneurismal changes. 3 cases (7.89 %) are still
recent study which 1/6cas (16/ 66%) in group 2 and 2/6
(33.33%) of the first sub group of group 4. Visceral
arteries remained patent in 100 % of cases.
Conclusion: MLS may be an option treatment for
dissections and complex aortic aneurysms in frail patients
at high surgical risk. The results are interesting in false
aneurysms and true aneurysms without significant
collateral.