Challenges of endovascular tube graft repair of XXXX : midterm follow-up and lessons learned.

@entity1 @entity1070 @entity177 @entity2334 @entity439 @entity397 @entity1756
OBJECTIVES: Endovascular stent-graft repair has great potential in treatment of @entity2334 . This study analyzed a single center's experience with first-generation commercially produced thoracic stent grafts used to treat descending @entity2334 . METHODS: Over 58 months 84 @entity1 underwent endovascular stent-graft repair of descending @entity2334 ; 22 @entity1 received the Gore TAG stent graft, and 62 @entity1 received the Talent thoracic endovascular stent-graft system. Each @entity1 was enrolled in one of three distinct US Food and Drug Administration trials at Mount Sinai Medical Center in accordance with strict inclusion and exclusion criteria, including suitability for open surgery, @entity439 anatomy, and presence of comorbid medical illness. Mean age of this cohort was 71 +/- 12 years. There were 54 @entity1 and 30 @entity1 , and 74 (88%) had three or more comorbid illnesses. Primary technical success was achieved in 76 @entity1 (90%). Mean follow-up was 15 months (range, 0-52 months). RESULTS: Successful @entity439 exclusion was achieved in 69 @entity1 (82%). Major procedure-related or device-related complications occurred in 32 @entity1 (38%). There were six proximal @entity177 (8%), four @entity177 (6%), one intergraft failure (1%), two mechanical device failures (3%), five periprocedural deaths (6%), and five late @entity1756 (6%). At 40 months, overall survival was 67% (+/-10%), and freedom from @entity397 or from type I or @entity1070 was 74% (+/-10%). CONCLUSION: While promising, this midterm experience with commercially available devices highlights the shortcomings of current stent-graft technology. Three significant advancements are required to fulfill the potential of this important treatment method: a stent graft with a durable proximal and distal fixation device, enhanced engineering to accommodate high @entity2334 , and a mechanism to adapt to aortic arch and visceral segment branches to enable treatment of lesions that extend to or include these vessels.
