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Ann Thorac Surg 2008;85:S1-S41. doi:10.1016/j.athoracsur.2007.10.099
© 2008 The Society of Thoracic Surgeons
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Lars G. Svensson
Nicholas T. Kouchoukos
D. Craig Miller
Joseph E. Bavaria
Joseph S. Coselli
John A. Elefteriades
Raimund Erbel
Thomas G. Gleason
Bruce W. Lytle
Eric E. Roselli
Hazim J. Safi
Richard J. Shemin
Thoralf M. Sundt, III
Wilson Y. Szeto
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Report From The Society of Thoracic Surgeons Endovascular Surgery Task Force

Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts*

Lars G. Svensson, MD, PhDa,*, Nicholas T. Kouchoukos, MDb, D. Craig Miller, MDc, Joseph E. Bavaria, MDd, Joseph S. Coselli, MDe, Michael A. Curi, MD, MPAf, Holger Eggebrecht, MDg, John A. Elefteriades, MDh, Raimund Erbel, MDi, Thomas G. Gleason, MDj, Bruce W. Lytle, MDk, R. Scott Mitchell, MDl, Christoph A. Nienaber, MDm, Eric E. Roselli, MDk, Hazim J. Safi, MDn, Richard J. Shemin, MDo, Gregorio A. Sicard, MDp, Thoralf M. Sundt, III, MDq, Wilson Y. Szeto, MDr, Grayson H. Wheatley, III, MDs

a Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
b Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri
c Department of Cardiothoracic Surgery, Stanford University Medical School, Stanford, California
d Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
e Baylor College of Medicine, Houston, Texas
f Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Maryland
g Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
h Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
i Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
j Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
k Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
l Stanford University School of Medicine, Stanford, California
m University Hospital Rostock, Division of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
n University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Texas
o Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Cardiovascular Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
p Department of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri
q Mayo Clinic, Rochester, Minnesota
r Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
s Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, Arizona

* Address correspondence to Dr Svensson, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk F24, Cleveland, OH 44195 (Email: svenssl{at}ccf.org).

Between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and continues to increase. For the thoracic aorta, these diseases are increasingly treated by stent-grafting. No prospective randomized study exists comparing stent-grafting and open surgical treatment, including for disease subgroups. Currently, one stent-graft device is approved by the Food and Drug Administration for descending thoracic aortic aneurysms although two new devices are expected to obtain FDA approval in 2008. Stent-graft devices are used "off label" or under physician Investigational Device Exemption studies for other indications such as traumatic rupture of the aorta and aortic dissection. Early first-generation devices suffered from problems such as stroke with insertion, ascending aortic dissection or aortic penetration from struts, vascular injury, graft collapse, endovascular leaks, graft material failure, continued aneurysm expansion or rupture, and migration or kinking; however, the newer iterations coming to market have been considerably improved. Although the devices have been tested in pulse duplicators out to 10 years, long-term durability is not known, particularly in young patients. The long-term consequences of repeated computed tomography scans for checking device integrity and positioning on the risk of irradiation-induced cancer remains of concern in young patients. This document (1) reviews the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts; and (2) offers suggestions for treatment.




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