STUDIES SUPPORT STENT-GRAFT TREATMENT AS FIRST LINE OF CARE FOR THORACIC AORTA REPAIR

A nonsurgical treatment using stent-grafts to repair injured or diseased thoracic aortas offers patients less risk of paraplegia -- as well as lower morbidity and mortality rates -- when compared with surgery, according to two studies recently presented to the Society for Interventional Radiology.

There is higher risk of paraplegia during surgery because the thoracic aorta is clamped, cutting off blood to the spinal column. The interventional radiology treatment with stent-grafts does not stop blood flow because the endograft is advanced inside the artery, using imaging to guide it from the femoral artery in the groin to the damaged area.

The first study, conducted in London, analyzed 190 patients from 1997 to 2006. The patients had diseased aortas in the thoracic area. In the second study, conducted in Canada, all of the patients were healthy, but each had suffered a violent life-threatening injury to the thoracic portion of the aorta. Since there was no underlying pathology in the Canadian study, adverse events were not due to underlying disease and could be more clearly linked to the procedure.

The incidence of death and permanent paralysis in the London group, which only included the interventional treatment, was 1.6 percent. The trauma study, which also included a comparison with surgery, had a 7.4 percent incidence of pneumonia and no deaths or paralysis in the interventional patients. In the surgery group, there was an 11 percent occurrence of death, a 15.6 percent incidence of paralysis and a 37.5 percent incidence of pneumonia.