Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms: A Ten-Year Experience with 817 Patients

Michael L. Marin, Larry H. Hollier, Sharif H. Ellozy, David Spielvogel, Harold Mitty, Randall Griepp, Robert A. Lookstein, Alfio Carroccio, Nicholas J. Morrissey, Victoria J. Teodorescu, Tikva S. Jacobs, Michael E. Minor, Claudie M. Sheahan, Kristina S. Chae, Juliana Oak, Andrew Cha, Gregorio A. Sicard, Richard P. Cambria, D. Craig Miller, William C. Krupski

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Abstract

Objective: On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was perfonned in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. Summary and Background Data: Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality. Methods: Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed. Results: The mean age was 74.3 years (range, 25-95 years); 678 patients (83%) were men; 86% had 2 or more comorbid medical illnesses, 67% of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8% of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 ± 6% at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 ± 1% at 9 years. There was a 2.3% incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months. Conclusions: Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms.

Original languageEnglish (US)
Pages (from-to)586-595
Number of pages10
JournalAnnals of Surgery
Volume238
Issue number4
StatePublished - Oct 2003
Externally publishedYes

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Thoracic Aortic Aneurysm
Abdominal Aortic Aneurysm
Stents
Transplants
Aneurysm
Aortic Aneurysm
Rupture
Therapeutics
Endoleak
Equipment and Supplies
Mortality
Incidence
North America
Coronary Artery Disease
Thrombosis
Pathology
Morbidity
Health

ASJC Scopus subject areas

  • Surgery

Cite this

Marin, M. L., Hollier, L. H., Ellozy, S. H., Spielvogel, D., Mitty, H., Griepp, R., ... Krupski, W. C. (2003). Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms: A Ten-Year Experience with 817 Patients. Annals of Surgery, 238(4), 586-595.

Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms : A Ten-Year Experience with 817 Patients. / Marin, Michael L.; Hollier, Larry H.; Ellozy, Sharif H.; Spielvogel, David; Mitty, Harold; Griepp, Randall; Lookstein, Robert A.; Carroccio, Alfio; Morrissey, Nicholas J.; Teodorescu, Victoria J.; Jacobs, Tikva S.; Minor, Michael E.; Sheahan, Claudie M.; Chae, Kristina S.; Oak, Juliana; Cha, Andrew; Sicard, Gregorio A.; Cambria, Richard P.; Miller, D. Craig; Krupski, William C.

In: Annals of Surgery, Vol. 238, No. 4, 10.2003, p. 586-595.

Research output: Contribution to journalArticle

Marin, ML, Hollier, LH, Ellozy, SH, Spielvogel, D, Mitty, H, Griepp, R, Lookstein, RA, Carroccio, A, Morrissey, NJ, Teodorescu, VJ, Jacobs, TS, Minor, ME, Sheahan, CM, Chae, KS, Oak, J, Cha, A, Sicard, GA, Cambria, RP, Miller, DC & Krupski, WC 2003, 'Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms: A Ten-Year Experience with 817 Patients', Annals of Surgery, vol. 238, no. 4, pp. 586-595.
Marin ML, Hollier LH, Ellozy SH, Spielvogel D, Mitty H, Griepp R et al. Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms: A Ten-Year Experience with 817 Patients. Annals of Surgery. 2003 Oct;238(4):586-595.
Marin, Michael L. ; Hollier, Larry H. ; Ellozy, Sharif H. ; Spielvogel, David ; Mitty, Harold ; Griepp, Randall ; Lookstein, Robert A. ; Carroccio, Alfio ; Morrissey, Nicholas J. ; Teodorescu, Victoria J. ; Jacobs, Tikva S. ; Minor, Michael E. ; Sheahan, Claudie M. ; Chae, Kristina S. ; Oak, Juliana ; Cha, Andrew ; Sicard, Gregorio A. ; Cambria, Richard P. ; Miller, D. Craig ; Krupski, William C. / Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms : A Ten-Year Experience with 817 Patients. In: Annals of Surgery. 2003 ; Vol. 238, No. 4. pp. 586-595.
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abstract = "Objective: On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was perfonned in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. Summary and Background Data: Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality. Methods: Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed. Results: The mean age was 74.3 years (range, 25-95 years); 678 patients (83{\%}) were men; 86{\%} had 2 or more comorbid medical illnesses, 67{\%} of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8{\%} of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 ± 6{\%} at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 ± 1{\%} at 9 years. There was a 2.3{\%} incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months. Conclusions: Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms.",
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T1 - Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms

T2 - A Ten-Year Experience with 817 Patients

AU - Marin, Michael L.

AU - Hollier, Larry H.

AU - Ellozy, Sharif H.

AU - Spielvogel, David

AU - Mitty, Harold

AU - Griepp, Randall

AU - Lookstein, Robert A.

AU - Carroccio, Alfio

AU - Morrissey, Nicholas J.

AU - Teodorescu, Victoria J.

AU - Jacobs, Tikva S.

AU - Minor, Michael E.

AU - Sheahan, Claudie M.

AU - Chae, Kristina S.

AU - Oak, Juliana

AU - Cha, Andrew

AU - Sicard, Gregorio A.

AU - Cambria, Richard P.

AU - Miller, D. Craig

AU - Krupski, William C.

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N2 - Objective: On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was perfonned in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. Summary and Background Data: Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality. Methods: Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed. Results: The mean age was 74.3 years (range, 25-95 years); 678 patients (83%) were men; 86% had 2 or more comorbid medical illnesses, 67% of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8% of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 ± 6% at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 ± 1% at 9 years. There was a 2.3% incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months. Conclusions: Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms.

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