Tratamiento endovascular de la aorta torácica mediante endoprótesis con escotadura distal

• Autores: Marcio Fernando Maciel da Rocha
• Directores de la Tesis: Vicente Riambau Alonso (dir. tes.)
• Lectura: En la Universitat de Barcelona ( España ) en 2011
• Idioma: español
• Tribunal Calificador de la Tesis: José Luís Pomar Moya Prats (presid.), Purificacion Matute Jimenez (secret.), María Pilar Tornos (voc.)
• Materias:
  • Ciencias médicas
    • Medicina interna
• Enlaces
  • Tesis en acceso abierto en:  TDX  Dipòsit Digital de la UB  TESEO 
• Resumen

  • “ENDOVASCULAR TREATMENT OF THORACIC AORTA WITH SCALLOPED THORACIC ENDOGRAFTS” Endovascular treatment of thoracic aortic disease (ETTAD) is often the only option for patients unfit for open surgery. The proximity of the celiac and superior mesenteric artery in the presence of short distal aortic neck is a major limitation of endoluminal intervention. Various approaches to the problem were developed, but still there is no consensus on the best management. The scalloped thoracic stent graft is an advance in the ETTAD. It improves distal sealing and fixation and maintains the flow to the visceral arteries. There are few data in the literature about its use. The hypothesis of the thesis is that the use of a custom-made thoracic stent graft reduces morbidity and mortality in the presence of short distal aortic neck. Thus, the purpose of this study is to determine the feasibility and impact on mortality, and overall morbidity and neurological damage, of the introduction of a scalloped thoracic stent graft in the ETTAD. This work comes from a line of surgery research, "Endovascular treatment of thoracic aorta”, and is divided into two parts which have resulted in two papers published before. To review the experience with hybrid surgery techniques to treat aneurysms of the thoracic aorta in the presence of short distal aortic neck, we used the information from the prospective database of vascular surgery department, Hospital Clinic of Barcelona, in an observational, longitudinal, retrospective, uncontrolled study. We included patients with degenerative aneurysm of the thoracic aorta, who underwent arch and visceral hybrid surgeries. To be evaluated the technical feasibility and experience with a custom-made scalloped thoracic endograft using the Relay platform (Bolton Medical, Sunrise, FL) as an alternative to treat the distal aortic neck with suboptimal configuration, to improve distal fixation and sealing, keeping the flow to the visceral arteries, it was carried out the second work. We studied 57 patients with thoracic aortic disease undergoing surgery with this device, in an observational, longitudinal, prospective, multicenter, uncontrolled trial conducted in Europe. The results of the two works were compared. Quantitative variables were described as mean and qualitative variables as percent frequency. We used the Chi Square test to compare between-group categorical variables, Student t test for continuous variables with normal distribution. For variables without normal distribution, we used the Bonferroni method. The level of statistical significance was set at 5% bilateral. Technical success in patients treated with scalloped thoracic stent graft was 96.4% and 100% in those treated with hybrid intervention (p = 1.000). Reoperation was necessary in one patient in the arch hybrid surgery group (1%). Scalloped thoracic endograft when compared to hybrid surgery had less morbidity (p <0.0001) and postoperative complications (p <0.03). Compared to visceral hybrid variant, there was less morbidity, postoperative complications and mortality (p <0.0001). There were no significant differences with the results of neurological complications in both groups. The added knowledge of the doctoral thesis is that the introduction of the scalloped device is feasible. When compared with hybrid surgery techniques, the use of this thoracic endograft increases the results of ETTAD in selected cases, in the presence of short distal aortic neck.