Objective: Thoracic aortic stent-grafting(TASG) decreases perioperative complications in high-risk patients. Use of TASG in patients with connestive tissue diseases (CTD) remains limited. We herein report 3 patients with CTD who underwent TASG.
Results: Case 1: A 47 yo male Marfan patient was operated in 2001 for a thoraco-abdominal aneurysm. On routine chest computed tomography(CT), a large pseudoaneurysm at the proximal anastomosis was documented. The pseudoaneurysm was excluded with a 30mm Talent stent-graft (11%oversize). At 48 month follow-up, the patient shows complete regression of the pseudoaneurysm on CT.
Case 2: A 58 yo female with Ehlers-Danlos typeIV syndrome with a descending thoracic aneurysm resected in 1989 presented with an enlarging aneurysm distal to the graft. Three Talent stents (13% oversize) were deployed and balloon dilated to exclude the aneurysm. The immediate postoperative period was complicated by an extensive intramural hematoma of the aorta with hemothorax. She was treated conservatively and progressively resolved her intramural hematoma. At 32 month follow-up, the aneurysm is excluded without stent-graft complication.
Case 3: A 28 yo female Marfan patient had undergone a previous Bentall procedure followed five months later with a resection of the proximal descending aorta. Three months later a pseudoaneurysm at the distal anastomosis was diagnosed on CT and treated with a 24mm Valiant stent (33%oversize). A dissection distal to the stent was documented on the postoperative CT. Within 5 months the dissected aneurysm enlarged significantly with a type I distal leak. Concomitantly the patient suffered a class III dyspnea owing to a severe mitral regurgitation. The patient underwent a successful MVR and stent-graft excision with replacement of the descending aorta through a clamshell incision. Six months postoperatively the thoracic aorta is free of complications.
Conclusions: Although all stent-grafts were deployed in a Dacron graft at one extremity, significant complications supervened in 2 patients. We thus recommend that deploying a stent-graft in a CTD diseased aorta should be considered a relative contraindication. In cases where an open operation is prohibitive, use of a stent-graft with minimal radial force and minimal oversizing without balloon dilatation should be considered.