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In a recent mid-term study thoracic endografts were compared to open surgical repair for treatment of thoracic aneurysms. The device (TAG endoprosthesis by W.L. Gore and associates) was approved by the FDA in March 2005, and its use in this study proved superior to surgical repair. There were few endoleaks, interventions or late deaths. Results of this research were presented at the 60th Annual Meeting of the Society for Vascular Surgery.

“Patients treated by minimally invasive endovascular means typically suffer less early complications than those treated by the standard open surgical therapy,” said lead investigator Michel Makaroun, MD, professor and chief of vascular surgery at the University of Pittsburgh School of Medicine. We compared 140 patients treated with the TAG device to 94 patients who had open surgery.

“Patients treated by the endovascular method had an impressive 60 percent reduction in total complication rate compared to open surgery. The death rate from the operation was reduced from 12 to two percent and paraplegia (paralysis of both legs) was down from 14 to three percent. Strokes were equivalent between the two treatment modes at four percent,” added Dr. Makaroun.

At four years, those treated by the endovascular method using the TAG device continued to show superior results in total complication rates compared to the group treated by open surgery. Only four patients in the endovascular group required a reinterventionone had a conversion to an open procedure because of infection and died. The other three had a minimally invasive insertion of additional TAG devices to correct a poor seal from the original operation and had no complications of the reinterventions.

Dr. Makaroun said there were no aneurysm ruptures. There was no migration or motion of the devices inside the aneurysm of any clinical significance. Complications like endoleaks (or continued flow into the aneurysm sac) diminished over the four years to 5 percent. The endoleaks related to small branches of the aneurysm, were of much less significance in the thoracic than in the abdominal aorta. Sac sizes from one to 48 months decreased in 46 percent and increased in 24 percent of the patients. “Although sac increases are concerning, early results from the commercially released modified device indicate this issue may be resolved,” said Dr. Makaroun.  “Endovascular treatment of aortic aneurysms in the chest is only the beginning of a new era of treating many vascular thoracic problems, such as trauma, dissection and other emergencies with endografts.